Monday, February 1, 2016

Changes in Out-Of-Pocket Costs for Hormonal IUDs After Implementation of the Affordable Care Act: An Analysis of Insurance Benefit Inquiries

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.

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.

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.

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

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.

Below:  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.

Below:  In each age group: percentage of women who would have had out-of-pocket costs for a hormonal IUD, by quarter

Below:  In each region: percentage of women would have had out-of-pocket costs for a hormonal IUD, by quarter

Full article at:

  • 1Guttmacher Institute, New York, NY 10038, USA. Electronic address:
  • 2Guttmacher Institute, New York, NY 10038, USA. 
  •  2016 Feb;93(2):139-44. doi: 10.1016/j.contraception.2015.08.018. Epub 2015 Sep 16.

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