Does Health Insurance Cover Sexual Health Services?
Does health insurance cover birth control?
Yes. Most health insurance plans must cover the full range of prescription birth control methods for free with no copay, coinsurance, or other out-of-pocket costs, even if you haven’t met your deductible. This includes birth control pills, implants, IUDs, the vaginal ring, the patch, the shot, internal condoms, diaphragms, cervical caps, tubal ligation (aka female sterilization), and emergency contraception.
But some plans require cost-sharing for certain brands of birth control, which means you may have to pay some of the cost out of pocket. You can check with your health insurance provider to make sure your birth control is covered for free — and if it’s not, they can tell you how much it will cost. The nurse or doctor who is prescribing your birth control can also help you figure out if your health insurance covers the brand you need.
Health insurance plans are not required to cover methods that you can buy over-the-counter without a prescription (like standard condoms and spermicide). Plans are also not required to cover birth control for people with penises (like vasectomies, aka male sterilization) — but some may.
Some religious organizations are allowed to refuse to cover birth control in their health insurance plans for employees. Others may use a third-party contractor or separate insurer for birth control coverage. Contact your health insurance provider or employer for more information.
There are limited Medicaid programs that only cover family planning services (like birth control). Contact your state’s Medicaid agency to find out if you’re eligible.
If you need birth control that’s not covered by your health insurance, or you don’t have health insurance, call your local Planned Parenthood health center to see if they have any programs to help you get birth control for free or low-cost.
Does health insurance cover abortion?
The ACA does not require health insurance plans to cover abortion services, like in-clinic abortion and the abortion pill. But some plans do cover abortion. The best way to find out if you have coverage for abortion services is to contact your health insurance provider.
Abortion coverage varies depending on a lot of factors, like the laws where you live, what type of insurance you have, and the reason you need an abortion. Many private health insurance plans cover abortion, but some choose not to or aren’t allowed to in certain states. Some states ban all health insurance plans from covering abortion, while other states require all plans to cover abortion or don’t place limits on abortion coverage. Some states ban certain types of insurance from covering abortion, like ACA marketplace plans and/or Medicaid. Some plans will only cover an abortion under special circumstances, like if the pregnancy is the result of rape or incest, or it puts your life at risk.
Planned Parenthood opposes laws and policies that restrict coverage for abortion. We believe everyone deserves access to the health care they need.
If you need an abortion and you’re worried about cost, contact your local Planned Parenthood to see if they can help you get care. You can use abortionfinder.org to find your closest abortion provider. The National Network of Abortion Funds may also be able to help you cover the cost of your abortion.
Does health insurance cover STD testing?
Yes, most of the time. Testing for certain STDs — like HIV, syphilis, chlamydia, and gonorrhea — is one of the preventive health benefits that most plans must cover under the ACA. But whether your plan covers a specific STD test can depend on a lot of different things, including your age, gender, risk factors, and if you’re pregnant.
Under the ACA, all insurance plans must cover HIV testing for everyone ages 15 to 65, as well as other ages if you have a higher risk for getting HIV. Coverage for other STD tests, like syphilis, chlamydia, and gonorrhea, may vary. These tests are often part of your preventive care benefits, so they’re free with no copay, coinsurance, or other out-of-pocket costs even if you haven’t met your deductible. Other times you may have to pay a copay, or some or all of the costs.
Talk with your nurse or doctor or call your health insurance provider to find out what STD tests are covered for you, and how much they’ll cost if you do have to pay out of pocket.
If you need STD testing or treatment that’s not covered by your health insurance, or if you don’t have health insurance, call your local Planned Parenthood health center to see if they can help you get care for free or low-cost. You may also be able to get free or low-cost STD testing from your local health department, family planning clinics, or community health care centers.
Does health insurance cover emergency contraception (aka the morning-after pill)?
Yes. But it can get a little complicated, depending on the type you need. Under the ACA, most health insurance plans must cover all methods of birth control that you can get with a prescription, including emergency contraception.
There are three kinds of emergency contraception: certain IUDs, the ella morning-after pill, and the Plan B (and other generic versions) morning-after pill.
The most effective type of morning-after pill is ella. You need a prescription to get ella — which means that most health insurance plans will cover ella at no cost to you.
You don’t need a prescription to get Plan B or other brands of levonorgestrel morning-after pills, such as Take Action, My Way, and AfterPill. You can buy them over-the-counter at drugstores, pharmacies, superstores, and online. Health insurance won’t pay for these types of morning-after pills if you buy them over-the-counter without a prescription. But if you get a prescription, most health insurance plans will cover them at no cost to you.
You can get a prescription for morning-after pills from your nurse or doctor (like the ones at your local Planned Parenthood health center). In some states, you can also get a prescription from a pharmacist. Because ella is the most effective type of morning-after pill, it’s a good idea to ask for it specifically. If you want levonorgestrel (aka Plan B) morning-after pills, you may have to explain to your nurse, doctor, or pharmacist why you’re asking for a prescription, since a prescription is not needed to buy it; tell them your health insurance will only cover the cost if you have a prescription.
It’s a good idea to get morning-after pills ahead of time and keep them in your medicine cabinet — just in case. That way if you need it, you can take it as soon as possible. So if there’s ever a chance you might need emergency contraception, call your nurse or doctor and ask for a prescription, or get a prescription at your next appointment. You won’t have to worry about trying to get it at the last minute and the cost will be covered by your health insurance.
If you get certain IUDs up to five days after unprotected sex, it’s a very effective way to prevent pregnancy. A nurse or doctor needs to prescribe an IUD and put it in, so IUDs are also covered by most health insurance plans.
Does health insurance cover wellness exams?
Yes. Most health insurance plans must cover preventive health care for free with no copay, coinsurance, or other out-of-pocket costs, even if you haven’t met your deductible. This includes wellness exams — gynecological exams, annual exams, or “well woman” exams — for people under 65. Wellness exams include services like pelvic exams, Pap tests, breast exams, STD testing, and birth control counseling — all covered under health insurance.
Other preventive care services, like vaccines, cholesterol screenings, blood pressure screening, and certain mental health screenings are also covered under most health insurance plans.
Most plans cover at least one wellness visit per year. But they may cover other preventive services, tests, and screenings more or less often, depending on the current medical guidelines and your own personal medical history. You can talk with your doctor or call your health insurance provider for more information on coverage for preventive services. Read more about preventative care benefits.
If you don’t have insurance, the costs for these services can vary. Your nearest Planned Parenthood health center can talk with you about your options for affordable care. Many people qualify for free or low-cost wellness exams at Planned Parenthood health centers.