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 New Jersey, the Health Insurance Marketplace operates under a state-based exchange known as Get Covered New Jersey (GetCoveredNJ). Residents looking for health insurance can visit the GetCoveredNJ website to explore their options, determine eligibility for premium subsidies, and enroll in a plan during the open enrollment period or during special enrollment periods if they qualify due to life events. Plans offered through GetCoveredNJ are required to cover a range of contraceptive methods and counseling for women without charging copayments or coinsurance, even before the deductible is met, as long as 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 exempt religious employers do not have to cover contraceptives, and employees may need to pay out-of-pocket for these services. Non-profit religious organizations with objections to contraceptive coverage do not have to pay for such coverage, but their insurance providers or third-party administrators must offer separate payments for contraceptive services, allowing employees to access these services without copayments, coinsurance, or deductibles.
