Privately Insured Women Increased Use of Long-Acting Reversible Contraception After ACA, Study Finds

May 15, 2019

Four-by-four graphic of 16 types of contraception

WASHINGTON, DC (March 13, 2018) -- Under the Affordable Care Act (ACA), most private insurance plans have been required to cover all FDA-approved forms of contraception without cost-sharing since the 2013 plan year. An analysis of private insurance claims from 2006-2014 for women ages 13 to 45 found a small but statistically significant increase in insertions of long-acting reversible contraceptive (LARC) devices after the ACA's contraceptive mandate took effect. The authors report this and other results in a study published in Women's Health Issues, "The Impacts of the Affordable Care Act on Contraceptive Use and Costs among Privately Insured Women."

Women's Health Issues is the official journal of the Jacobs Institute of Women's Health, which is based in the Department of Health Policy and Management at Milken Institute School of Public Health at the George Washington University.

Ashley H. Snyder and colleagues at Penn State College of Medicine used health claims data from the Truven Health Analytics MarketScan database and identified claims for prescription contraceptives -- including contraceptive pills, patches, rings, and injections as well as insertion of LARC methods (intrauterine devices and contraceptive implants). They examined costs to the women receiving the methods and found a dramatic decrease in out-of-pocket costs, with the median costs for pills, rings, patches, IUDs, and implants dropping to $0 in 2013 and 2014. 

Other recent studies have also found dramatic drops in out-of-pocket contraceptive costs following implementation of the ACA's contraceptive mandate, the authors note, but findings on changes in types of contraceptives used have been mixed. This study used claims data from private health plans serving employees in all 50 states and the District of Columbia, and found a statistically significant 3% increased odds of LARC insertion after the mandate's implementation. The authors note that the finding "suggests that the removal of the cost barrier to IUDs and implants has increased their rate of adoption."

Snyder and her co-authors point out that the future of cost-sharing-free contraceptive coverage is uncertain. (The Trump Administration has issued a rule making it easier for employers to opt out of the ACA's contraceptive mandate, but it has been stayed while courts consider legal challenges.) Given their findings, they conclude, "If more health plans were to become exempt from coverage, out-of-pocket spending for contraception would be expected to increase."

"The Impacts of the Affordable Care Act on Contraceptive Use and Costs among Privately Insured Women" has been published online ahead of print and will appear in the May/June Women's Health Issues.