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. 2016 Feb;93(2):139-44.
doi: 10.1016/j.contraception.2015.08.018. Epub 2015 Sep 16.

Changes in out-of-pocket costs for hormonal IUDs after implementation of the Affordable Care Act: an analysis of insurance benefit inquiries

Jonathan M Bearak  1 , Lawrence B Finer  2 , Jenna Jerman  2 , Megan L Kavanaugh  2
Affiliations

Changes in out-of-pocket costs for hormonal IUDs after implementation of the Affordable Care Act: an analysis of insurance benefit inquiries

Jonathan M Bearak et al. Contraception. 2016 Feb.

Abstract

Background: The Affordable Care Act (ACA) requires that privately insured women can obtain contraceptive services and supplies without cost sharing. This may substantially affect women who prefer an intrauterine device (IUD), a long-acting reversible contraceptive, because of high upfront costs that they would otherwise face. However, imperfect enforcement of and exceptions to this provision could limit its effect.

Study design: We analyzed administrative data for 417,221 women whose physicians queried their insurance plans from January 2012 to March 2014 to determine whether each woman had insurance coverage for a hormonal IUD and the extent of that coverage.

Results: In January 2012, 58% of women would have incurred out-of-pocket costs for an IUD, compared to only 13% of women in March 2014. Differentials by age and region virtually dissolved over the period studied, which suggests that the ACA reduced inequality among insured women.

Conclusions: Our findings suggest that the cost of hormonal IUDs fell to US$0 for most insured women following the implementation of the ACA.

Implications: Financial barriers to one of the most effective methods of contraception fell substantially following the ACA. If more women interested in this method can access it, this may contribute to a decline in unintended pregnancies in the United States.

Keywords: Contraception; Healthcare reform; IUD; Insurance; LARC; Out-of-pocket costs.

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Figures

Fig. 1
Fig. 1
Percentage of women who would have had out-of-pocket costs for a hormonal IUD, by month. Note: The lighter line begins in January 2013 because the 2012 data do not contain insertion copayments and deductible applicability.
Fig. 2
Fig. 2
In each age group: percentage of women who would have had out-of-pocket costs for a hormonal IUD, by quarter.
Fig. 3
Fig. 3
In each region: percentage of women would have had out-of-pocket costs for a hormonal IUD, by quarter.
See this image and copyright information in PMC

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