Online Program

Assessing insurance coverage of abortion and contraception in the 2015 Illinois Health Insurance Marketplace

Monday, November 2, 2015

Lee Hasselbacher, JD, Department of Obstetrics & Gynecology, University of Chicago, Chicago, IL
Kathy Waligora, MSW, EverThrive Illinois, Chicago, IL
Lindsay Pluff, MPH, EverThrive Illinois, Chicago
background: The Affordable Care Act requires contraceptive coverage at no additional cost to the consumer in most plans. Information on implementation of this requirement among insurance carriers offering plans on the Illinois Health Insurance Marketplace has been scarce. Abortion coverage information is also unclear. This study assessed information about contraception and abortion coverage in sample plans offered on the Illinois Marketplace in 2015.

methods: We reviewed sample plans from three different geographic regions in Illinois in each of the four metal groups (Bronze, Silver, Gold and Platinum) offered by all nine insurers. We assessed whether there was clear access to information regarding coverage for contraception and abortion within available Summary of Benefits documents, formularies, websites and through phone calls to customer representatives.

results: Several insurance carriers offered clear information and covered a wide range of contraceptive methods at no additional cost to the consumer. Other carriers did not provide conclusive information regarding which methods were included in the formulary or offered most methods with additional cost-sharing requirements. Most carriers provide little or no information about abortion coverage; some that did only mentioned coverage in circumstances where the woman’s life was in danger.

discussion: Access to accurate information about reproductive health coverage and no-cost coverage for a wide range of contraceptive methods can be important factors for individuals selecting a plan. Carriers providing clear, consumer-friendly information regarding benefits and no-cost coverage of contraceptive methods from all FDA-approved categories should be referenced as models for all plans.

Learning Areas:

Conduct evaluation related to programs, research, and other areas of practice
Public health or related laws, regulations, standards, or guidelines
Public health or related public policy

Learning Objectives:
Describe the coverage of contraception and abortion offered by qualified health insurance plans (QHPs) in the 2015 Illinois health insurance marketplace. Identify successful approaches by insurance carriers to promote consumer transparency and comprehensive coverage; identify barriers consumers face in selecting plans with reproductive health coverage that fits their needs.

Keyword(s): Health Insurance, Reproductive Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a policy researcher with the Section of Family Planning and Contraceptive Research and I have researched and written about the Affordable Care Act, contraceptive coverage, and abortion access, including for peer-reviewed publications. One of the co-authors and I organized a city-wide summit to discuss policy around contraceptive coverage and affordability among academics, government agencies, and health advocate organizations.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.