Most women can expect to get contraceptives without paying out of pocket for them thanks to the federal Affordable Care Act.
But there’s a catch. Many of the state and local health departments, community health centers, Planned Parenthood clinics and other family planning centers that serve these women don’t accept insurance, not even publicly funded insurance such as Medicaid. Not yet, anyway.
To take advantage of required insurance coverage of these benefits under the law, the centers will have to learn the ins and outs of contracting with insurers and beef up their computer systems pronto, according to a study by the Guttmacher Institute, a reproductive health organization.
“If your patient has insurance but you as a clinic don’t take insurance, it’s not going to do you much good,” says Adam Sonfield, an analyst at the Guttmacher Institute who co-authored the study.
It won’t do patients much good either. Roughly a quarter of women who need birth control rely on publicly funded family planning centers.
In 2010, family planning centers reported that only 60 percent of their clients had public or private insurance, according to the Guttmacher report. Some women receive services through state or federal programs like the Title X family planning program, while others pay out of pocket, often on a sliding scale based on income.
Under the health care overhaul that will change drastically. Starting in 2014, most people will be required to have insurance or pay a penalty. Medicaid eligibility will expand in many states to people with incomes up to 138 percent of the federal poverty level, and many other people will be eligible for subsidized coverage on state-based health insurance exchanges.
And the health law requires new plans or those that lose their grandfathered status to provide a range of preventive benefits, including birth control, without patient cost-sharing.
The Guttmacher study found that overall, only a third of family planning centers had contracts with private insurers in 2010. Forty percent had contracts with Medicaid health plans.
“For all family planning centers, becoming adept at working with health plans as a way to secure third-party reimbursement for insured clients will be necessary to thrive in the emerging health care marketplace,” the report concludes.