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

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.

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:   http://goo.gl/0ilVW4

By:  Bearak JM1, Finer LB2, Jerman J2, Kavanaugh ML2.

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

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