A Substantial Share of Women with Private Insurance are Paying for Some or All of the Cost of their Contraceptives Indicating Plans May Not Be Complying with the Affordable Care Act

November 4, 2022 - A new KFF survey finds that more than three-quarters (77%) of females ages 18-49 favor making birth control pills available without a doctor’s prescription if research shows they are safe and effective. Among those who favor making birth control pills available over the counter and who currently use prescription oral contraception, 60% say they would be likely to use over-the-counter birth control pills. Most say the main reason is convenience (59%).

Many females who would be unlikely to use over-the-counter birth control pills (46%) or are unsure (14%) say the main reason is they don’t currently use birth control pills nor plan to use them in the future (53%). Among those who use oral contraception, the main reason is they would prefer to talk to a provider before starting or refilling their birth control. Other reasons include concerns about safety, cost, and health insurance coverage.

While the Affordable Care Act (ACA) has required most insurance plans to cover prescription contraceptives at no cost to patients for over a decade, 41% of females ages 18-49 are unaware of this requirement. One-quarter of these females with private insurance say they paid at least part of the cost of their contraceptive care out-of-pocket. A growing number of reports note that some insurance plans are failing to comply with the ACA’s contraceptive coverage requirement, which has been scaled back through regulations and court decisions.

These survey findings come as the U.S. Food and Drug Administration decides whether to approve a progestin-only oral contraceptive pill (Opill) for over-the-counter status, making it as accessible as pain relievers and allergy medications.

Periodically conducted since 2001, the 2022 KFF Women’s Health Survey includes a nationally representative sample of 5,201 people who say they were assigned female at birth (including those who identify as women or other genders). Our analyses present the state of contraceptive access and preferences, including differences in contraceptive use and experiences by income, race and ethnicity, and insurance status.

Additional findings include:

• The vast majority of females ages 18-64 (90%) have used contraceptives at some point in their reproductive years, and most have used more than one contraceptive method throughout their lifetime (76%).
• Most females get their birth control care at a doctor’s office (77%) and prefer to get their care there, even as more services have become available online. Clinics and health centers remain an essential source of contraceptive care, particularly for those who have low incomes (18%) or are uninsured (23%).
• One in five uninsured females say they had to stop using a birth control method because they couldn’t afford it.
• One-quarter of females aren’t using their preferred method of contraception, with many raising concerns about side effects and affordability. Only 30% of females say they received all the information they needed before choosing their birth control method.
• One in four females either don’t know emergency birth control pills are available over the counter or have never heard of them. Among those who have heard of emergency birth control pills and could become pregnant, three in ten (31%) say they don’t know where they could get them.

Learn more about the 2022 Women’s Health Survey findings in the report “Contraception in the United States: A Closer Look at Experiences, Preferences, and Coverage” and the brief “Interest in Using Over-the-Counter Oral Contraceptive Pills.”
Source; Kaiser Family Foundation