New research suggests that teenagers are more likely to choose long-acting contraceptives when cost is removed from the equation. And free coverage of such methods is required by the health law. But now, a study has found that free coverage of such methods too often still falls short.

The study, published in the journal Contraception by the Guttmacher Institute, found that insurance coverage of contraceptives without cost sharing has improved markedly since the health law’s requirement became effective for most women in 2013.

But gaps in coverage remain. The Guttmacher researchers analyzed the experiences of 892 privately insured women who used prescription contraceptives between the fall of 2012, before the law’s provisions took effect for most women, and the spring of 2014. It found that the proportion of women who paid nothing for their intrauterine devices increased from 45 percent to 62 percent during that time.  The proportion of women who had no cost sharing for injectable contraceptives grew from 27 percent to 59 percent. (There weren’t enough women using hormonal implants to include in the study.)

Some long-acting contraceptives such as IUDS can cost hundreds of dollars up front, putting them out of reach financially for some women unless insurance covers the cost.

Meanwhile, a new three-year study published in The New England Journal Of Medicine found that after teenagers received counseling about the effectiveness of various birth control methods, nearly three quarters who were offered long-acting contraceptives — like intrauterine devices or hormonal implants — at no charge picked them. The young women were not only more likely to choose long-acting methods, they were significantly less likely to get pregnant, give birth or have an abortion, the study found.

Why is free coverage of long-acting contraceptives—which can prevent pregnancy from three months up to 10 years—still lacking for roughly 40 percent of women?

“The biggest reason is probably the issue of grandfathered plans,” says Adam Sonfield, a senior public policy associate at the Guttmacher Institute and the study’s lead author. Plans that were in force in March 2010 when the health law passed and haven’t changed substantially since then aren’t required to provide free contraceptive coverage.

Religious employers, mainly churches, are also exempted.

In addition, some employers that have religious affiliations or that object to providing birth control on religious grounds can avoid covering birth control directly and do it instead through their insurer. Employees at these organizations should still receive FDA-approved contraceptives without any copayments or other types of cost sharing. Details on that process are still being worked out for the for-profit companies that assert religious concerns. 

In the long run, “the concept of a contraceptive coverage guarantee should help level the playing field and help people of all ages choose the method that will work best for them, without having to worry about whether this method will cost them more up front,” says Sonfield.

It’s good for insurance companies, too, says Sonfield. Avoiding an unplanned pregnancy, even with an IUD that may cost hundreds of dollars, is a lot cheaper than paying for pregnancy and birth.

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