Individual and Family

9 Essential Things You Need to know About Birth Control

Published on December 20, 2019

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Birth control is used to prevent pregnancy, and in some cases, treats PMS symptoms, acne, and conditions such as endometriosis. Birth control is covered under the Affordable Care Act’s minimum essential coverage and isn’t difficult to get, but you need a prescription from a doctor if you’re interested in receiving birth control.

Can you get birth control pills over the counter?

No, you cannot get birth control pills over the counter. You must get a prescription from a doctor.

You typically can get a prescription for birth control from your primary care prescription (PCP), an OBGYN, or via mail order birth control services, such as Nurx or the Pill Club. Check and make sure with your health insurance plan if they cover mail order services.

Additionally, it’s important to keep in mind that these birth control mail order services may be considered out-of-network depending on your health insurance plan. You can always call your health insurance provider to double-check, which pharmacies and mail order services are covered.

You can buy some forms of birth control over the counter such as

  • the sponge
  • external condoms
  • internal condoms
  • some emergency contraceptives – for example, Plan B.

These OTC medications are usually not covered by health insurance unless you can get a prescription. However, it is easy to get birth control items – such as in or out condoms – from your local Planned Parenthood at low or no cost.

Are birth control pills free?

Birth control pills aren’t free on their own; however, you can get birth control pills for free – or at relatively low cost – if you have ACA-compliant insurance.

According to Planned Parenthood, birth control pills can cost up to $50 without coverage but can be $0 with ACA-compliant coverage. Additionally, you will likely have to front the cost for the appointment to get a prescription for birth control – doctor’s visits can cost up to $250 – unless you have health insurance. However, you can get the pill prescribed online.

Due to a 2012 provision of the ACA, coverage for women’s and reproductive health care has been expanded, making these services included as a minimum essential benefit. Beginning on August 1, 2012, all health insurance plans were required to cover a prescription for most birth control methods.

10 essential benefits graphic

Plans that are sold through the health insurance marketplace must cover at least one option for each FDA-approved birth control methods for women without copays or deductibles.

The FDA-approved methods include

  • the implant
  • the pill
  • the patch
  • the shot
  • the ring
  • diaphragms
  • cervical caps
  • sterilization procedures
  • both hormonal and non-hormonal IUDs

Additionally, the ACA covers other female-centered health benefits, apart from birth control. Some benefits include:

  • Well-woman visits
  • Sexually transmitted infection (STI) counseling, including HIV
  • The HPV vaccine
  • Prenatal screening and tests
  • Breastfeeding counseling and supplies

How can I get birth control pills for free?

One option you have to get free – or extremely low-cost – birth control is to get ACA-complaint health insurance coverage. Of course, almost nothing is truly “free”—you only benefit from full coverage of birth control options if you are paying monthly premiums for a compliant health insurance plan.

To make sure your birth control expenses are completely covered, you can enroll in an ACA-compliant health insurance plan during the annual open enrollment period. The annual open enrollment period runs from November 1st through December 15th in most states every year for coverage starting the following year. Make sure to check your state though, because many states have extended open enrollment periods. Additionally, you can check if you qualify for a special enrollment period, which can happen at any time of the year, as long as you have a qualifying life event to justify it.

What if I am not covered?

If you are not covered, and it is not near the open enrollment period, you can get some coverage through short term health insurance plans. Not all short term plans provide coverage for prescription medications, such as birth control, but some do. While short term coverage is a great way to find some coverage when it’s outside of open enrollment, it’s important to keep in mind that you can be denied short term health insurance coverage based on preexisting conditions.

If you make below 133% of the federal poverty line (FPL) and are looking to get birth control – and other healthcare expenses covered – you may qualify for Medicaid or other government assistance.

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