Know Your Rights: Contraception Coverage in Colorado
Contraception is an important part of the care that every person deserves in order to achieve their own, self-determined reproductive well-being, and it is not a one-size-fits-all medical solution. In the US, a person who menstruates will try an average of (3) three methods of birth control over their reproductive years and nearly one-third will use five or more methods. There are many protections in place in both Colorado and federally that ensure consumers have access to the care they need.
June 24, 2022 - Colorado Governor Jared Polis released a statement following the alarming decision by the U.S. Supreme Court to strip away the freedom to end a pregnancy and the right to an abortion from millions of Americans, over turning decades of legal precedent, and endangering the rights of future generations.
The Reproductive Health Equity Act (House Bill 22-1279), signed by Governor Polis on April 4, 2022, codifies the legal right to abortion services services in Colorado law.
All Coloradans will continue to have access to abortion services, despite the Supreme Court ruling in Dobbs v. Jackson Women’s Health.
In Colorado, the Affordable Care Act (ACA) guarantees coverage of women’s preventive services, including free birth control and contraceptive counseling, for individuals and covered dependents. On June 27, 2022, Secretaries Xavier Becerra, Marty Walsh, and Janet L. Yellen of the U.S. Departments of Health & Human Services, Labor and Treasury (Departments), respectively, issued a letter to group health plans and health insurance issuers reminding them of their obligations under the ACA to provide coverage for contraceptive services, as outlined below, at no cost.
The Affordable Care Act (ACA) included a first-of-its-kind requirement that health insurance plans cover the full range of Food and Drug Administration (FDA)-approved birth control methods with no out-of-pocket expense to the consumer - that means consumers who can get pregnant can’t be charged a copay, coinsurance, or deductible for it.
- There are currently eighteen (18) different categories of FDA-approved birth control options, including, tubal ligation, various intrauterine devices (IUDs), implants, shots, oral contraceptives (sometimes known as “the pill”), patches, rings, diaphragms, sponges, cervical caps, internal condoms, spermicide, and emergency contraceptives (sometimes known as “Plan B”).
- The no-cost coverage also includes “contraceptive counseling, initiation of contraceptive use, and follow-up care (e.g., management, evaluation, as well as changes to and removal or discontinuation of the contraceptive method).”
Health plans and issuers must cover without cost sharing at least one form of contraception in each of the method categories, noted above, identified by the FDA. While health plans and issuers can use different medical management techniques, like imposing a cost-share on some methods within a category, to encourage a patient to use one medication in the same category over another, they cannot use those techniques to override the determination of a provider and the patient.
If you need to try a different medication or contraceptive item in a category (for example, you need to switch to a different type of oral contraception because the one you tried first didn’t work for you or you need to switch to a different hormonal IUD), you are able to do so at no cost to you. If you need to try something else, your health plan must:
- Have an exceptions process in place to cover (without cost to you) any necessary contraceptive service or item that is easily accessible, transparent, sufficiently expedient, and not unduly burdensome on you or your provider;
- Communicate that exceptions process to you and your provider; and
- Defer to your provider that the requested medication or item is medically necessary for you.
In Colorado, people who menstruate who have commercial insurance coverage can get twelve (12) months of a prescription oral contraceptive or three (3) months of a prescribed vaginal ring. So, when your provider gives you a prescription for either type of contraceptive, you can get a twelve-month or three-month supply at once.
If any of the following happen to you, you can contact the Division of Insurance for help:
- Your contraception (including Plan B) isn’t being covered at no-cost to you;
- The contraception that works best for you, as determined by you and your provider, isn’t being covered at all or at no-cost to you; or
- You want twelve months of oral contraception or three months of a vaginal ring, but your insurance won’t cover that quantity.
You can contact the Division of Insurance Consumer Service Team with questions about your health insurance plan or contraception benefits at:
303-894-7490; 800-930-3745 (outside the Denver Metro area)
Additional Information and Resources
Your health insurance policy should clearly explain the contraceptive benefits available to you. Under the ACA, non-exempt health plans regulated by the Colorado Division of Insurance (Division) must provide, with no out-of-pocket cost, at least one type of each of the 18 contraceptive methods currently approved by the Food and Drug Administration (FDA). Though contraception is provided is provided without cost by most health plans, there are certain circumstances where you may have to pay for these treatments, including:
- If you use a health care professional that is not in your plan's network;
- If your health insurance plan is provided by an exempted institution or company;
- If your health plan is considered a "grandfathered" plan, generally those sold before the ACA was enacted on March 23, 2010. Grandfathered plans are not required to provide coverage for contraception.
If you are unsure if your health insurance plan is regulated by the Division, you can take a look at your insurance card to see if it has “CO-DOI” on it. Don’t see it or still unsure? You can still contact the Consumer Services Section to get help or pointed in the right direction.
Your health insurance company with questions about your contraceptive benefits.
The Division of Insurance Consumer Service Team with questions about your health insurance plan or contraception benefits at:
800-930-3745 (outside the Denver Metro area)