Coverage of Contraception and Abortion 
in Illinois' Qualified Health Plans

June 2015

The Section of Family Planning and Contraceptive Research, along with EverThrive Illinois, conducted a review of contraception and abortion coverage among health insurance plans offered on Illinois' health insurance marketplace. The authors reviewed the scope of contraception and abortion coverage, as well as ease of access to information regarding these benefits. The authors also reached out to each of the carriers prior to public release of this report to discuss findings and provide an opportunity to respond.

Download a copy of the report here.

Executive Summary

The Patient Protection and Affordable Care Act (ACA) is improving health coverage for tens of millions of Americans by expanding access to health insurance and establishing stronger consumer protections. One of the key provisions affecting women's health is the requirement that nearly every health insurance plan provide coverage for certain preventive services, including the full range of FDA-approved contraceptive methods without cost sharing. This provision is estimated to save the average woman up to $600 per year.

The ACA created new health insurance marketplaces where consumers can purchase individual and family plans. In Illinois, these plans, called "qualified health plans" or QHPs, are currently available through healthcare.gov, a portal that allows consumers to compare plan benefits and prices. To evaluate coverage options for women purchasing insurance through the marketplace in Illinois, EverThrive Illinois and The Section of Family Planning and Contraceptive Research at the University of Chicago conducted a review of contraception and abortion coverage for a selection of qualified health plans.

This review revealed significant barriers to understanding coverage for both contraception and abortion among QHPs currently available on the Illinois marketplace, including numerous instances in which consumer facing materials were not aligned with internal policies and instances in which information about covered services could not be fully accessed without logging into a member portal. Additionally, this review highlighted considerable need for additional training and resources for customer service representatives, particularly regarding abortion care.

While this review revealed that carriers are offering, and updating, coverage for many contraceptive methods, it also revealed the use of medical management techniques to limit access to certain contraceptive methods. These tactics step therapy, and, most commonly, limiting coverage to generic products. This review found that two of the eight insurance carriers were not compliant with the ACA requirement to provide coverage for the full range of FDA-approved contraception.

In 2015, women represent 54% of individuals enrolled in qualified health plans made available through state and federal marketplaces. Access to effective contraceptive methods can help women to plan their pregnancies, improve birth spacing, and avoid unintended pregnancy—all of which lead to significant health, social, and economic benefits. Knowledge about abortion coverage alongside other reproductive health care services will give women a complete understanding of their benefits. Carriers must comply with the requirements of the ACA and ensure women have easy access to reliable information without judgment.

Acknowledgements

This report was prepared by Lindsay Pluff, MPH and Kathy Waligora, MSW from EverThrive Illinois and Lee Hasselbacher, JD from The Section of Family Planning and Contraceptive Research at the University of Chicago.

This report was made possible with generous support from Raising Women's Voices, the National Institute for Reproductive Health, and the Irving Harris Foundation. Additionally, individuals from the National Women's Law Center, the National Health Law Program, the AIDS Foundation of Chicago, and Northwest Health Law Advocates (NoHLA) provided valuable feedback and support. We also thank those who participated in the 2014 Illinois Contraceptive Equity Summit for contributing to initial conversations on this topic. The authors would also like to thank Dr. Andrea Jones for her valuable research assistance and input.

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