IUDs Are Still Fully Covered Under the Affordable Care Act

 

On Friday U.S. District Judge Reed O’Connor of the U.S. District Court for the Northern District of Texas ruled in the Texas v. United States court case that the Patient Protection and Affordable Care Act  (ACA)— a.k.a. Obamacare — is unconstitutional in its entirety. 

Legal experts have stated that the ruling will not immediately affect healthcare coverage, and California and several other states have already vowed to appeal the decision. The Healthcare.gov website, which is the official home of the ACA’s Health Insurance Marketplace, added a notice to its homepage stating “Court’s decision does not affect this season’s open enrollment.” Barring a last-minute extension, this year’s open enrollment period is schedule to close at midnight tonight (12/15/2018), a day after O’Connor’s ruling.

The ACA has come under intense attacks from both President Donald Trump and the Republican-controlled Congress in recent years. Republicans seem determined to dismantle former president Barack Obama’s landmark legislation, a move that threatens the life and well-being of millions of America’s most vulnerable citizens.

In the last major legal challenge to the ACA, back in 2012, Supreme Court Chief Justice John Roberts cast the deciding vote to preserve the law. That was before moderate Supreme Court Justice Anthony Kennedy resigned and was replaced by the more conservative Justice Brett Kavanaugh

No one, not even the Republicans trying to repeal the ACA, has a clear idea of what a replacement for the ACA might look like.

That is making a lot of people who could not afford health insurance without the ACA uncomfortable. In addition to those who rely on their ACA insurance plans to cover necessary and even life-saving medications and treatments, there are also millions more people who rely on the ACA to provide routine preventative care and birth control.

If Trump’s executive order to reinstate the “Mexico City Policy” — which prohibits the U.S. government from providing funding to foreign nongovernmental organizations that perform abortions or even offer information about them — or a previous Senate vote to strip the ACA of birth-control coverage are any indicator, then a Republican-inspired replacement for the ACA probably would not be big on reproductive health benefits.

However, if the Supreme Court were to uphold O’Connor’s decision, there is one way to ensure that you have affordable — essentially free —birth control for years to come even if the ACA is repealed. All health insurance plans offered through the federal marketplace cover all costs associated with an intrauterine device, or IUD. You don’t even have to pay a copay for the doctor’s visit, and you don’t have to meet your deductible first.

As an added bonus, an IUD could very well outlast the Trump presidency.

Despite free birth control being available through all ACA plans since the bill was signed into law in March of 2010, a lot of people still do not realize that IUDs are fully covered under their insurance plan.

I was a licensed insurance agent for the first two years that the ACA was in effect, and I always mentioned IUDs to people who asked about birth control coverage. I cannot recall a single instance in which the client was not surprised to learn that IUDs are fully covered.

It is perfectly reasonable to assume that IUDs might not be covered the same way that birth control pills or barrier methods are covered because IUDs require a medical procedure, which would normally have considerable costs associated with it. There also has not been a concerted effort to make the public aware that IUDs are covered under the ACA.

The ACA, however, does not distinguish between birth control methods in regard to coverage. If a method is FDA-approved, it is fully covered under all ACA plans offered through the marketplace.

“Plans in the health insurance marketplace must cover contraceptive methods and counseling for all women, as prescribed by a health care provider,” the Healthcare.gov page on birth control benefits explains. “Plans must cover these services without charging a copayment or coinsurance when provided by an in-network provider — even if you haven’t met your deductible.”

The full list of birth-control methods currently covered under all ACA plans includes:

    • Barrier methods, such as diaphragms and sponges
    • Hormonal methods, such as birth control pills and vaginal rings
    • Implanted devices, such as intrauterine devices (IUDs)
    • Emergency contraception, such as Plan B and ella
    • Sterilization procedures
    • Patient education and counseling

For those in need of affordable birth control, the part about copays, coinsurance, and deductibles is crucial, especially in regard to having an IUD implanted. The implant procedure can cost up to $1,000 or more without insurance coverage, but, again, it is totally free under the Affordable Care Act. You should not even have to pay the copay for the doctor’s visit.

“I was overjoyed to find that my insurance fully covers an IUD, and then I realized that I was rejoicing about something that should be a given, not a luxury — but it sure feels like one,” Amy Caffee, a mother of two from Charleston, South Carolina, wrote in a Facebook post.

Caffee confirmed to The Progressive Standard that under her ACA plan she did not have to pay a copay or coinsurance related to the IUD implant procedure. She also noted that you can receive the implant on the same day you have your initial consultation.

The website for Planned Parenthood provides an abundance of general information about IUDs, as well as information on the process for having an IUD implanted, what to expect afterwards and how IUD removals work.

The cost of removal is also fully covered under the ACA. However, if the law is repealed, some insurance plans may not cover that expense in the future.

Planned Parenthood offers IUD removals on a sliding scale based on income. That could be an affordable option for having an IUD removed should the ACA be fully repealed or stripped of the birth-control benefits down the road.

As the Planned Parenthood website points out, an IUD can last for up to 12 years. That gives IUD users a long time to plan ahead for the removal or replacement.

That’s also long after Trump himself will have been replaced.

“I just love the idea of a single B.C. device that will outlast Trump,” one Facebook user commented on Caffee’s post. “Poetic, really.”

Of course there are always potential risks with any medical procedure or implant. An IUD may not be an ideal option for everyone, but if the ACA is going to be repealed, which may be a possibility, then an IUD might be an option for the those who feel comfortable with the process and whose healthcare providers recommend it.

If you don’t currently have health insurance coverage, you have until midnight on December 15th (that is tonight) to enroll in an ACA plan during the open-enrollment period (again, barring an extension of the deadline). If you miss the deadline, you may be eligible for a “special enrollment” if you experience certain life-changing events, such as moving to a different zip code, losing your coverage from an employer, or getting married or divorced.

There are affordable, or even free, plans available for people who need assistance paying for their health insurance, especially for those with incomes in the roughly $13,000 to $20,000 range. People earning less may be eligible for Medicaid or other programs in certain states.

For instance, a 25-year-old woman living in Tampa, Florida, and earning $15,000 a year can get a Bronze insurance coverage plan for free, or a Silver plan starting at about $20 a month, according to the estimator on the Healthcare.gov website. The same women earning $20,000 a year could get a Bronze plan for a few dollars a month or a Silver plan starting at about $75 a month. Again, IUDs would be fully covered under the Bronze plans without having to pay a deductible or copay.

All coverage begins on the day your policy is enacted, so you can get an IUD as soon as your coverage kicks in. There are no waiting periods for any services covered under the ACA.

There are a couple of exceptions and potential obstacles to keep in mind though. Some group plans were grandfathered in under the Affordable Care Act and are not required to cover all of the same services as marketplace plans. IUDs might not be covered under such plans. You’ll want to check with your insurance provider or human resources representative for details.

Insurance companies also still have a tendency to reject claims that they are required to cover under the ACA. As an insurance agent, I spent a lot of time on the phone making three-way calls between clients and customer care representatives for insurance providers. The customer service representatives often did not realize, or at least pretended not to realize, that providers were mandated by law to cover certain services.

As an agent, I could sometimes talk the customer service representatives through the issue and get the claim processed. Other times, I would have to call a broker representative to have the matter addressed. Broker representatives only speak with insurance agents and brokers, and are far more familiar with the details of the ACA. They also want agents to keep enrolling people in their company’s policies, so they tend to be very helpful with sorting out claims.

If you have an issue with an insurance provider not wanting to process a claim for an IUD, or any other benefit that should be covered, contact your insurance agent, human resources representative, or healthcare provider. They know the law, and they know how to talk to insurance providers. They speak the same jargon-filled language of the health-insurance industry.

 
 

*A slightly different version of this article originally appeared at Defiant on January 27, 2017. Featured image: Photo of an IUD by Sarah Mirk via Flickr under Creative Commons Attribution 2.0 Generic (CC BY 2.0) license.

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