The Need for Insurance Coverage for Contraceptives

Contraception is a basic health need for women. It prevents unintended pregnancy, helps women plan their pregnancies and reduces the need for abortion. Nonetheless, many private health insurance plans still do not cover contraceptives even if they cover other prescription medications.

The lack of contraceptive coverage is costly for both insurers and the public. For insurers, costs arise from having to pay for pregnancy-related care or for abortion. For women and their families, costs range from out-of-pocket payment for contraceptives to unintended pregnancy.

The Costs

Some insurance companies argue that it would be expensive to offer this coverage. But studies show that preventing unintended pregnancy saves money. Compare these costs:

$10,000: Average mother and infant cost for one pregnancy

$450: Average cost for first trimester abortion

$300: Average cost for one-year supply of birth control pills

Weighed against the high costs of labor, delivery and health care for unplanned pregnancy, all methods of prescription contraception (for example, the pill, Depo Provera, Norplant, the IUD, emergency contraception, the diaphragm) are cost effective.

Some employers also argue that it would be too expensive for them to offer this coverage. The reality is that it would cost an employer only $1.43 per employee per month to add full contraception benefits to a health plan.

Equitable Coverage

Health Insurance companies have come a long way in correcting inequities in the coverage they offer. For example, many health care services for women and children, once considered non-essential, are now covered. These include services such as prenatal care, mammography, and even childhood immunizations.

Yet a vastly different scenario exists for contraceptive coverage. Less than 20 percent of traditional health plans and only 40 percent of managed care plans provide coverage for all of the most frequently used methods of prescription contraception.

Furthermore, in comparing the cost of healthcare for women versus men, the inequity is even more apparent. American women pay 68 percent more in out-of-pocket costs for health care than men, mainly because of this lack of insurance coverage for contraceptives. This inequality discriminates against women, barring them from exercising their right to prevent, plan and space pregnancies.

Status of Contraceptive Coverage Legislation across the Nation

Congress has covered contraceptives in federal employees’ insurance plans for the past four years. In addition, legislation known as “The Equity in Prescription Insurance and Contraceptive Coverage Act “ (EPICC), currently in a Senate committee, would establish parity for prescription contraceptives in insurance companies that cover other prescriptions.

Across the nation, twenty-four states have enacted contraceptive equity legislation.

Status of Contraceptive Coverage Legislation in New Jersey

In December 2005, the New Jersey Assembly approved S.556 (previously passed by the state Senate), a contraceptive equity bill, without loopholes! Once signed by Acting Governor Codey, NJ became the twenty-fourth state to require contraceptive equity in insurance coverage.

Sources:
Institute of Medicine, "The Best Intentions: Unintended Pregnancy and the Well-Being of Children and Families" (1995);

Trussell, "The Economic Value of Contraception: A Comparison of 15 Methods", American Journal of Public Health, Vol. 85, No. 4 (April 1995);

AGI - Alan Guttmacher Institute, “The Need for and Cost of Mandating Private Insurance Coverage of Contraception”, The Guttmacher Report on Public Policy, Vol. 1, No. 4, (August 1998).