Women’s Awareness of Their Contraceptive Benefits Under the Patient Protection and Affordable Care Act

The Patient Protection and Affordable Care Act mandates that there be no out-of-pocket cost for Food and Drug Administration–approved contraceptive methods. Among 987 privately insured reproductive aged Pennsylvania women, fewer than 5% were aware that their insurance covered tubal sterilization, and only 11% were aware that they had full coverage for an intrauterine device. For the Affordable Care Act contraceptive coverage mandate to affect effective contraception use and reduce unintended pregnancies, public awareness of the expanded benefits is essential.

Half of the pregnancies in the United States are unintended.1 Cost is a barrier to contraceptive use; in fact, when contraception is provided at no cost, women choose more effective and more expensive methods, such as long-acting reversible contraceptives (LARCs)—which include intrauterine devices (IUDs) and contraceptive implants—and have fewer unintended pregnancies.2,3 The Patient Protection and Affordable Care Act (ACA; Pub L No. 111–148) eliminates the cost barrier to contraception for most women with private health insurance by mandating coverage without patient cost sharing for Food and Drug Administration–approved contraceptive methods and tubal sterilization.4 Although this contraceptive coverage requirement went into effect in August 2012,5 whether privately insured women are aware of their newly expanded contraceptive benefits is unknown.

...Privately insured women are largely unaware of their contraceptive benefits under the ACA, and a substantial proportion would switch methods if there were no cost barrier. It is unclear whether the high proportion of women reporting “I don’t know” about coverage reflects a lack of method awareness or a lack of knowledge about coverage, which is a study limitation.

Before the ACA, studies suggested that full contraceptive coverage could increase use of LARCs and reduce unintended pregnancies and abortions. In 2002, the Kaiser Foundation Health Plan in California sent quarterly outreach publications to inform enrollees of their policy change to include 100% coverage of injectables and LARCs, resulting in a significant increase in the use of these methods.7 In the CHOICE project, women in the St. Louis, Missouri, region received dedicated counseling promoting LARCs and were provided no-cost contraception, resulting in a high uptake of LARCs and a reduction in unintended pregnancy.3 These demonstrations suggest that the ACA mandate may not lead to more effective contraceptive method use without efforts to inform both women and health care providers of the coverage mandate and to provide accurate information about method options. Furthermore, it is not clear whether insurers are complying with the mandate8 or if there is an adequate workforce to provide LARCs.9 Although system-level barriers to female sterilization under Medicaid regulations are well recognized, low awareness of coverage for sterilization may prove to be a barrier even among privately insured women.10

For the ACA contraceptive coverage mandate to affect the use of effective contraception, raising women’s awareness of the expanded benefit is an essential first step. Private insurers, health care providers, and policymakers must do a better job of communicating the benefit, or this could be a missed opportunity to reduce unintended pregnancies and abortions among US women.

Below:  Awareness of contraceptive coverage based on the question, “To the best of your knowledge, does your health insurance policy currently cover these birth control methods at no cost to you (no copay or deductible payment)?”: Pennsylvania, 2014. Note. IUD = intrauterine device. The sample size was n = 987.

Full article at:  http://goo.gl/QT25sl

By: Cynthia H. Chuang, MD, MSc, Julie L. Mitchell, DO, Diana L. Velott, MPA, MS, Richard S. Legro, MD, Erik B. Lehman, MS, Lindsay Confer, MPH, and Carol S. Weisman, PhD

Cynthia H. Chuang is with the Division of General Internal Medicine, Penn State College of Medicine, Hershey, PA. Julie L. Mitchell is with the Department of Medicine, Penn State College of Medicine. Diana L. Velott, Erik B. Lehman, Lindsay Confer, and Carol S. Weisman are with the Department of Public Health Sciences, Penn State College of Medicine. Richard S. Legro is with the Department of Obstetrics and Gynecology, Penn State College of Medicine.

Corresponding author.

Correspondence should be sent to Cynthia H. Chuang, MD, MSc, 500 University Drive, HO34, Division of General Internal Medicine, Penn State Hershey, Hershey, PA 17033 (e-mail: ude.usp.cmh@gnauhcc). Reprints can be ordered at http://www.ajph.org by clicking the “Reprints” link.

Contributors

C. H. Chuang was the principal investigator for the MyNewOptions study; she conceptualized the study and wrote the article. J. L. Mitchell, D. L. Velott, R. S. Legro, E. B. Lehman, L. Confer, and C. S. Weisman contributed to data interpretation and to writing the article. E. B. Lehman analyzed the data.

 

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