Should insurance be required to pay for ALL forms of contraception?

This has been bugging me for years…currently in most, if not all, of the U.S., there is no legal requirement for medical insurance to pay for abortion and/or contraception. I think this is insane, especially the latter, but that’s a separate issue (especially since I’ve never seen a plan that wouldn’t pay for surgical sterilization in lieu of contraception, or a plan that wouldn’t pay for maternity care, and you’d think it would be much cheaper to pay for contraception).

Of those plans that do cover contraception, though, I’ve never seen one that would cover any form of it other than birth control pills. My problem with this is that they are not the best option for many, many women. You have to remember to take them reliably for them to do any good, among other things.

More importantly for purposes of this OP, however, they are a really bad idea, medically speaking, for many women. Bad if you smoke, bad if you have a history of hormonal imbalances, bad if you have a previous history of stroke, blood clots, cancers of the breast or reproductive organs, bad if you’re on certain other drugs, bad if you’ve had previous bad reactions to them…

So how can insurance companies get away with not making reversible alternatives available to their members, especially those for whom birth control pills are medically contraindicated? First, why wouldn’t they from a practical standpoint, since birth control pills are an ongoing expense in the neighborhood of $30 or so monthly, and other forms (an IUD or diaphragm) may be cheaper if you consider recurring vs. non-recurring costs? And second, has anyone sued an insurance company for denying reproductive health coverage? Or are insurance companies just betting that women with half a brain who can’t take pills and still don’t want to get pregnant will pay for their method of choice out-of-pocket?

Actually all the medical plans I’ve had in my working career would pay for a variety of contraceptive methods. I didn’t investigate IUDs on earlier plans, but they are covered on my current plan. My wife and I got a diaphram cost-free at one point. All our plans have covered oral contraceptives. My sister-in-law uses the injections and they are covered on her plan.

The US tends not to legislate things the free market has demand for. It’s in the best interests of the insurance providers to pay for contraceptives and a good many of them do, so there is no driving force for legislation. State-sponsored healthcare, and I’m familiar with the Texas Medicaid program, in some states also pays for multiple types of contraceptives.


Eve, we debated this topic here a few years ago. Or, maybe we were specifically debating birth control pills only. I’m a bit foggy.

You’ve made some good arguments as to why an insurance company ought to cover all birth control methods. This topic is difficult, because it revolves around a stopping point. Insurance can’t cover every conceivable beneficial item. There must be some limit. Wherever that limit is drawn, one can always make a case that it ought to be liberalized a bit. It’s like inviting people to a party. You always leave out someone who is just about as deserving as others who were invited.

Birth control has some characteristics of medical care, but not others. Birth control is a medical-type procedure, but the people who use it are not sick in any way. So, one can make a case either way on where this limit ought to be set.

Maybe insurance should cover those methods prescribed by doctors, such as pills and IUDs, but not over-the-counter methods like condoms. That would be one possible stopping point, anyhow.

personally I see no reason why insurance companies should pay at all for contraception. It is not a medical necessity, most forms are available over the counter, and it is a personal choice whether to use it or not.
If you are responsible enough to have sex you should be responsible enough to take care of your own contraceptive needs.
There are also many ways to get free contraceptives anyway through agencies like planned parenthood.

Ah, but december, some of the people who use contraception ARE sick in some way, thus part of my OP.

I was a prime example for a while there (although not anymore, thank goodness). A few years ago, I had some pretty hardcore surgery to put the fragments of my left leg bones back together. One post-surgical complication was a honking huge deep vein thrombosis (aka blood clot, up near my hip joint), which is a) common after leg surgery, especially when followed by long stretches of bed rest; and b) is even more common in this situation, even in young, healthy people with no other known risk factors, if, say, they were on birth control pills at the time of the accident which necessitated the surgery. As I’m sure most of you are aware, a clot like this can break loose and travel to the heart or lung, where it can block blood circulation and potentially prove fatal. This happened because my idiotic doc and/or the HMO were too cheap to order the inexpensive test that would have diagnosed the clot while I was still in the hospital the first time around, but that’s a rant for another day. Let’s just say they’re damn lucky I didn’t file a malpractice claim.

I was shipped straight back to the hospital the day after I’d been discharged and put on IV blood thinners, and spent almost another week in the hospital, which sure wasn’t cheap for my HMO (I didn’t pay a cent for that). Because of the DVT, my doc strictly forbid me to use birth control pills for as long as I was non-weight bearing on my leg, which turned out to be the better part of a year, and I had to have numerous debates with her over the relative merits and dangers of various forms of contraception vs. dangers of pregnancy before she finally agreed to put me back on a low-dose pill. (Ever try inserting a diaphragm accurately while standing on one foot and bracing yourself against the wall with one hand? I thought not.) In any case, my inability to use the one reversible form of contraception my insurance would cover was quite directly related to a medical issue, and I’m certainly not alone in that.

Now I can understand that insurance companies need to draw the line somewhere, and maybe a logical spot would be with those methods that require a prescription. (I can certainly see people with insurance handing out their free condoms to their friends who don’t have insurance, but that wouldn’t work so well with, say, a diaphragm.) But why won’t most insurance companies cover IUDs, Norplant, diaphragms, Depo-Provera, or the new Ortho-Evra thingie I’ve heard so much about?

The only OTC forms of contraception I’m familiar with are condoms, the sponge, and spermicides. Oh, and the rhythm method. These are also the forms with the highest failure rates, typically in the 15-20% range. And Planned Parenthood can get you stuff at a reduced rate, but it’s still not free.

As for the medical necessity part, pregnancy sets you up for all sorts of health problems like hypertension, gestational diabetes, kidney failure, you name it. It’s a lot more necessary than prescription diet pills or acne medication, which are almost universally covered.

And Rhapsody, my point is not whether responsible people use birth control when having sex, even if they have to pay out-of-pocket for it; of course they (and I) do. My point is that if insurance companies decide it’s in their interest to cover contraception at all, they should cover the form that makes the most sense for the patient based on some sort of logical medical and/or cost criteria.

BTW, I went to Planned Parenthood after my DVT episode. They wouldn’t help me for liability reasons, as they were afraid they would be unable to judge the related medical issues in a way that would be safe both for me and for them. They simply aren’t funded or staffed for that sort of thing. And although I was happy to pay, thy use a sliding scale based on income; not all services are free for everyone.

I still love Planned Parenthood, though! It just sucked that they couldn’t help me, specifically. I’m OK medically now, though, so back to my insurance.

What insurance company in their right mind wouldn’t cover contraceptives? Given the huge costs they’re set to incur whenever one of their female policyholders becomes pregnant, you’d think they’d stop just short of ramming them down their throats (or up their you-know-whats).

I think a lot of the reason insurance companies won’t pay for anything but the pill is a really fucked up view of the costs involved. Getting an IUD or norplant inserted runs a few hundred dollars, while the pill only runs $20 a month. So obviously it’s way more economical to pay for the pill. Except that the IUD and Norplant are one time costs and are cheaper per month of use than pills by quite a bit.

It’s the same kind of thinking that causes some plans to balk at paying all that extra money for pills but happily cover prenatal care, hospitalization for birth, and health problems related to pregnancy. You could buy a hell of a lot of pills for what it costs to have a baby.

What about more controversial forms of birth control? Such as the morning after pill or RU486?

A woman in Seattle sued her insurance company for not covering birth control.
and the result was… she won!

By the way, "Eighty percent of employers who offer HMO plans to their employees include some form of contraception as part of the plan, according to the Kaiser Family Foundation. "

I’ve got a couple of issues with this.

In the first place, where does the government derive the power to force insurance companies to offer ANY particular form of coverage?

Also, as a pro choice person, I am glad that there are several hundred different insurers out there that offer a diverse menu of health care options at a variety of prices. If I want a plan that offers birth control, then I can choose to purchase that plan(what a concept). If I do not wish to pick that option, I can choose not to purchase that particular plan.

Thirdly, why do you think health care premiums are so damn expensive? A major reason is because of the mandates that the government has forced upon health care providers. Shit like a 48 hour manditory stay in the hospital for women who have just given birth, whether they need it or not, is very costly.

Another reason I see fault with this is that I think insurance should only be for unforeseen high cost procedures. Not everyday things like birth control pills or checkups or vaccinations. Think about it, your automobile insurance is for high dollar stuff like collisions or personal injury for which the average person would have a hard time paying out of pocket. It doesn’t cover things like oil changes and routine maintanance.

Cat Patrol, I think you’re missing one of my main points. I didn’t intend for the OP to be “should gov’t require insurers to offer contraception?” but “Given that some insurers have seen it in their best interests to offer contraception, should they offer any form of contraception which meets the best standard of medical care for patients, rather than the one form which, for some Godawful reason, they have decided will have to work for everybody?”

To me this is an example, albeit far less extreme, akin to deciding that all cancer patients will undergo radiation, even if chemo or surgery might be a better option in that specific case. Other forms of contraception might even be cheaper in many cases than what ins. companies have decided to provide; why can’t this decision, like most medical decisions, be made by a doctor based on what is appropriate for each individual?

Then why did you phrase the Topic line as “Should insurance be required to pay for ALL forms of contraception?”?

tracer, the “all” part of that OP was equally important.

Or to clarify in yet another slightly different way, “Given that some insurers offer contraception, should they be required to offer any and all forms of contraception which meet the best standard of medical care for their patients, especially given the known and severe potential medical consequences of using inappropriate forms of contraception in many cases?”

It may not be medically necessary, but it would probably save the insurance companies money in the long run to cover at least some forms of it. Look at it like a yearly physical: a seemingly healthy person may well not need to see the doctor once a year, but in doing so might discover that they have something wrong with them. Some of those things, if caught early, are much cheaper to treat then than they will be if the problem isn’t diagnosed. It’s cost effective to discover problems and treat them early, right? It’s also cheaper to cover birth control than it is to cover a pregnancy, a birth, and a whole new dependent on someone’s health insurance policy.

Again, it still comes down to the magical word required.

Would it be in the best interests of health insurance companies to cover all forms of contraception? Probably, considering the medical costs incurred by a pregnancy. Should they be required to cover them? Not unless you believe that health insurance = socialized medicine.

I don’t believe at all that health insurance = socialized medicine.

I do believe, however, that if insurance companies have undertaken to provide coverage for treating a particular condition, then they should do so in the most medically appropriate way. Birth controls pills, for many women, are NOT the most appropriate method of contraception, and can cause dangerous, or even fatal complications.

Speaking as a woman who can’t use hormonal birth control (no pills, shots, implants or patches for me), I am damn glad that my insurance covers all forms of contraception. I had an IUD placed after I had Aaron, and the device alone cost $600.00. The placement (five minutes’ worth of my OB’s time) was another $200. If my insurance didn’t pay for non-drug birth control, I’d be forced to use condoms, which have a much higher failure rate (15%, according to this site than my IUD does (<1%, according to the manufacturer’s patient information booklet). To deliver a baby, by comparison, costs about $10,000.

That being said, I don’t think contraception should be divided into separate categories, with the exception of surgical vs. non-surgical procedures. Yes, I know the pill is relatively cheap, and I know that some forms are available over the counter at no cost to insurance at all. But I think it’s doing a grave disservice to women to force them into a choice between something that may not work for them (like the pill) and something that may not work as well (like condoms). In short, insurers should cover ALL forms of contraception. To do anything less is vastly unfair to women.


Okay, since people are bitching about the use of the word required, let’s just rephrase the thread title to read “Should insurance plans that cover the pill be required to cover all forms of birth control?” That’s what the OP is actually asking, not whether the government ought to mandate contraceptive coverage. Does that clear everything up for everyone?

My first question is since when is fertility a medical condition that needs treatment ? Secondly, just because birth control pills are not appropriate does not mean that that only methods that require a doctor are appropriate.And do we even know that many insurers cover the cost of birth control pills prescribed for the purpose of birth control. I know most of the prescription coverages I’ve had specifically excluded it for that purpose, and I’ve had friends who got birth control pills for “irregular periods”, at least as far as the insurance company knew.

How about condoms, foam etc? And then what about all over the counter products? Why should my insurer pay for a prescription antibiotic cream but not the over the counter one?

Just because insurance doesn’t cover the IUD doesn’t mean the insurance is preventing you from having it. Neither my vision care plan nor my HMO will cover laser surgery for my husband. The vision plan is limited to exams, glasses and contacts.That doesn’t mean the companies are forcing my husband to wear glasses. It just means we’ll have to pay for the surgery ourselves.