Contraceptive Exceptions.pdf

The Affordable Care Act requires insurance plans to cover at least one contraceptive in each FDA-approved method category without cost-sharing, but many plans only cover one type per category, leaving people to pay out of pocket or forgo birth control if they need a specific type not usually covered. Exceptions policies, also known as waivers, can help people get no-cost coverage of specific contraceptives, but many insurance companies and states are not aware of or do not enforce this requirement, resulting in people paying out-of-pocket or using a contraceptive that does not meet their needs. Advocates can work with state insurance departments to improve compliance with exceptions policies by adopting a standard procedure for requesting exceptions, creating a standard form, and engaging in public education. A good policy should codify the basic requirements in the ACA guidance, including having an exceptions process, not second-guessing the healthcare provider's determination, and having an easily accessible and transparent process.