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 Texas, the Health Insurance Marketplace is a platform where individuals can find, compare, and purchase health insurance plans if they do not have coverage through an employer or another government program. The federal government operates the Marketplace in Texas through HealthCare.gov, as Texas does not have its own state-based Marketplace. During the annual open enrollment period, Texans can select health plans that must include certain essential health benefits, including contraceptive methods and counseling for women, as mandated by the Affordable Care Act (ACA). These services are covered without copayments or coinsurance when provided by an in-network provider, even if the deductible has not been met. However, plans in the Marketplace are not required to cover drugs to induce abortions or services related to male reproductive capacity, such as vasectomies. For individuals working for religious employers or non-profit religious organizations with objections to contraceptive coverage, the rules may differ. Certain exempt religious employers do not have to cover contraceptives, and employees may have to pay out-of-pocket. Non-profit religious organizations with objections to contraceptive coverage do not have to pay for such coverage, but separate payments for contraceptive services will be made by insurers or third-party administrators, allowing employees to access these services without cost-sharing.
