The Health Insurance Marketplace—also known as the Health Insurance Exchange—is the place where people without health care insurance can find information about health insurance options and also purchase health care insurance. Information can also be found regarding eligibility for help with paying premiums and reducing out-of-pocket costs. Each year the Marketplace has an open enrollment period.
In addition to the federally-facilitated Marketplace (HealthCare.gov), there are also state-based Marketplaces. Whether you use the federally-facilitated Marketplace or a state-based Marketplace depends on the state in which you live. If you visit HealthCare.gov you will be asked to provide your ZIP code. If you live in an area served by a state-based Marketplace, you will then be redirected to the website of your state-based Marketplace.
Plans in the Marketplace must cover contraceptive methods and counseling for all women, as prescribed by a health care provider. Plans must cover these services without charging a copayment or coinsurance when provided by an in-network provider—even if you haven’t met your deductible.
Covered contraceptive methods
Contraceptive methods covered by plans in the Marketplace include FDA-approved contraceptive methods prescribed by a woman’s doctor, including:
• Barrier methods, like diaphragms and sponges
• Hormonal methods, like birth control pills and vaginal rings
• Implanted devices, like intrauterine devices (IUDs)
• Emergency contraception, like Plan B® and ella®
• Sterilization procedures
• Patient education and counseling
Plans aren’t required to cover drugs to induce abortions and services for male reproductive capacity, like vasectomies.
Birth control benefits rules for employer-provided coverage
If you work for a religious employer
Health plans sponsored by certain exempt religious employers—like churches and other houses of worship—don’t have to cover contraceptive methods and counseling.
If you work for an exempt religious employer and use contraceptive services, you may have to pay for them out-of-pocket. Contact your employer or benefits administrator for more information.
If you work for a non-profit religious organization
Some non-profit religious organizations—like non-profit religious hospitals and institutions of higher education that certify they have religious objections to contraceptive coverage—don’t have to contract, arrange, pay, or refer for contraceptive coverage.
• If your health plan is sponsored or arranged by this type of organization, an insurer or third-party administrator will make separate payments for contraceptive services that you use.
• You’ll have access to contraceptive services without a copayment, coinsurance, or deductible when they are provided by an in-network provider.
In Hawaii, the Health Insurance Marketplace operates under a state-based exchange known as the Hawaii Health Connector. This allows residents to shop for and enroll in insurance plans that meet their needs. During the annual open enrollment period, individuals without health insurance can explore their options, determine their eligibility for subsidies, and purchase coverage. All plans in the Marketplace, including those in Hawaii, are required to cover a range of FDA-approved contraceptive methods without charging copayments or coinsurance, even if the deductible has not been met, as long as the services are provided by an in-network provider. This includes barrier methods, hormonal methods, implanted devices, emergency contraception, sterilization procedures, and related education and counseling. However, plans are not mandated to cover abortion-inducing drugs or male reproductive services like vasectomies. For those employed by religious organizations, the coverage for contraceptives may vary. Certain religious employers are exempt and do not have to cover contraceptives, potentially leading to out-of-pocket expenses for employees. Non-profit religious organizations with objections to contraceptive coverage are not required to pay for such coverage, but their insurance providers or third-party administrators must offer separate payments for contraceptive services, ensuring employees have access without copayments, coinsurance, or deductibles.
