Cost is a clear obstacle to contraceptive choice, particularly for women seeking methods with substantial upfront costs, such as the IUD. A new Guttmacher study published in the journal Contraception highlights the importance of the contraceptive coverage guarantee of the Affordable Care Act (ACA) in reducing these cost barriers. The study found that 87% of insured women would not have had to pay out of pocket for a hormonal IUD by the spring of 2014, a substantial increase from the 42% of women who would not have had to pay out of pocket before the implementation of the ACA provision in 2012. This increase occurred across all age-groups and regions of the country.

"This study adds to the growing body of evidence on the ACA’s impact on women’s contraceptive access," said Megan Kavanaugh, a Senior Research Scientist at the Guttmacher Institute and one of the authors of the article. "Women seeking a hormonal IUD—one of the most effective forms of contraception available—may be dissuaded from obtaining one because of high out-of-pocket costs. As this study documents, the ACA is making these more expensive methods a realistic option for many women. More women can now choose a birth control method based on what works best for them as opposed to what they can afford."

Bayer Healthcare, the manufacturer of two of the hormonal IUDs available in the United States, offers a voluntary service through which health care providers can inquire about a patient’s insurance coverage for an IUD before providing it. Guttmacher researchers analyzed more than 400,000 such inquiries made between January 2012 and March 2014 to determine whether each woman’s insurance would have covered a hormonal IUD and the extent of that coverage. The analysis differs from other published work because it assessed potential costs for women who were considering IUDs, not just costs for women who succeeded in obtaining one.

Hormonal IUDs are just one of many methods for which women are seeing an increase in coverage without cost sharing as a result of the ACA. A previous Guttmacher analysis documented a clear decline in out-of-pocket costs for women across a range of methods after the ACA’s contraceptive coverage mandate went into effect. Taken together, these studies highlight the impressive strides made in ensuring that women are able to choose the method that best meets their needs without having to worry about cost.

However, the study also indicates that not all women are adequately covered under the guarantee, as 13% of the women studied in March 2014 still faced out-of pocket costs to obtain a hormonal IUD. Exceptions that have limited the scope of the ACA’s contraceptive mandate include the contraceptive exclusion extended to some religious employers and grandfathered insurance plans (plans given a temporary reprieve from many of the ACA’s rules). Even as grandfathered plans become increasingly rare, some women covered by private insurance may still have to pay up to the full cost of the IUD and other contraceptives and associated services.

"Thanks to the ACA, growing numbers of women are able to obtain birth control methods that were once unaffordable," says Adam Sonfield, Senior Public Policy Associate at the Guttmacher Institute. "The reach of these benefits will continue to expand moving forward. As more plans lose grandfathered status and become subject to the ACA’s guarantee, and as plans adapt to federal guidance making it clear that the guarantee encompasses the full range of 18 methods for women, fewer women will experience gaps in coverage."

"Changes in out-of-pocket costs for hormonal IUDs after implementation of the Affordable Care Act: an analysis of insurance benefit inquiries" by Jonathan M. Bearak, Lawrence B. Finer, Jenna Jerman and Megan L. Kavanaugh is currently available online and will appear in a forthcoming issue of Contraception.

Disclaimer: Although Bayer Healthcare provided the data for this analysis, the company did not provide any financial support for the study or have any influence on the results. The conclusions and opinions expressed are the authors’ alone.