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Many women in the U.S. have gotten used to getting birth control free, thanks to the passage of the Affordable Care Act almost a decade ago, which required most employers to fully cover contraceptive care. But that could soon change for some women who get insurance through their work: Last week, the Supreme Court let stand a Trump administration rule allowing employers to stop covering birth control if they object to it on religious or moral grounds.
“Now, with impunity, businesses, companies, organizations, and educational institutions have the power to deny coverage for the most private of decisions—family planning,” Frederick Isasi, executive director of Families USA, a healthcare advocacy organization, said in a statement.
It could be several months before that change takes effect, says Tim Yost, professor emeritus at Washington and Lee University in Lexington, Va. Yost wrote an analysis of the decision for the Commonwealth Fund, a healthcare research center.
An estimated 126,000 women could be affected soon, according to the Department of Health and Human Services. But the number of women who could have their birth control coverage dropped could ultimately swell to nearly 2.9 million, Yost says, if other employers opt to take advantage of the rule.
Without that coverage, women will have to pay for birth control—not just the pills, injections, and other products but also the associated office visits—out of their own pockets, says Laurie Sobel, J.D., associate director for women’s health policy at the Kaiser Family Foundation, a nonprofit health research center.
And birth control can be expensive. Annovera, a vaginal ring, runs about $2,000 per month without insurance; the Xulane patch, about $130 per week; and a Depo-Subq Provera injection, about $250 every three months. Even birth control pills can be pricey: Taytulla and Natazia for example, can cost around $200 for a month’s supply.
Freya Riedlin, federal policy counsel at the Center for Reproductive Rights, a nonprofit organization, says people who can’t afford those costs will have to “forgo care,” and that is likely to have an even bigger effect on low-income women and women of color. “It exacerbates the existing disparities they already face in access to care,” she says.
The court’s decision limiting access to birth control comes as millions of people—especially women and people of color—have lost jobs and, as a result, health insurance, because of unemployment triggered by the COVID-19 pandemic.
If you are in either situation, here’s what you need to know now and what you can do to get birth control free of charge or at a low cost.
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It’s important to know that the Supreme Court Decision does not apply if you purchased health insurance on your own through a state or federal marketplace—in other words, if you have an Affordable Care Act (ACA), or “Obamacare,” plan.
It also doesn’t apply if you get health insurance through any government program, including Medicaid, Tricare (for veterans and their families), or Medicare, Sobel says.
If you get insurance through your employer, the new mandate also might not apply to certain plans if you work in Washington., D.C., or any of these 11 states: California, Delaware, Illinois, Massachusetts, Maryland, Maine, Nevada, New York, Oregon, Vermont, and Washington. All of them have passed laws, not affected by the Supreme Court decision, requiring some employers to provide birth control.
If you live elsewhere and your employer says it will no longer cover birth control, start by talking with your company’s human resources department, Sobel says. Specifically, ask whether, instead of getting your birth control through the company, you could get it directly from the insurance company the employer works with or the plan’s third-party administrator. That’s because some employers have elected to provide an “accommodation” for female employees—industry parlance meaning that the employer doesn’t directly pay for birth control, but a third-party they work with might, according to the Kaiser Family Foundation.
If you’ve lost insurance entirely because you’ve lost your job, see whether you qualify for Medicaid or an ACA plan, including one with a subsidy. To find out, go to HealthCare.gov to answer several screener questions to determine your eligibility, get connected with the appropriate program, and determine when coverage can begin.
Affordable Birth Control Without Insurance
If your employer no longer plans to cover birth control and won’t offer an accommodation, or if you don’t have insurance at all, here are some ways to get birth control paying little or nothing out of pocket, if you already have a prescription for birth control pills.
Look for discount coupons. You can find almost two dozen birth control pills for $45 per month or less, without insurance, through coupons offered through GoodRx. Search for the type of birth control you take, then print out or download a coupon you can take to a retail pharmacy near you.
Take advantage of drugstore programs. Walmart offers several birth control pills, including Norethindrone and Sprintec, for $4 for a month’s supply and $10 for a three-month supply.
Walgreens Prescription Savings Club (PDF) has options ranging from $13 to $30 for Levora, Necon, Jolivette, and Lutera pills. An annual membership, which also includes many other low-cost drugs, costs $20 for an individual or $35 for a family.
CVS recently discontinued its low-cost prescription program and instead offers a free pharmacist consultation to help find low-cost options for all prescription medication, including birth control.
Check with a local, independently owned pharmacy. These mom-and-pop pharmacies may be willing to negotiate on prescription drug prices, or help find a lower price, says Brian Caswell, Pharm.D., owner of Wolker Drugs in Baxter Springs, Kan., and president of the National Community Pharmacists Association.
Low-Cost Contraceptive Care
If you don’t yet have a prescription for birth control, there are several ways to get low-cost contraceptive counseling visits.
Telehealth: A number of telehealth services are now available, with at least a dozen promising very low costs on birth control visits. And it is okay to get some birth control prescriptions—especially for pills, vaginal rings, and other user-controlled methods—without an in-person physical exam, says a spokesperson for the American College of Obstetricians and Gynecologists, adding that you will need an office visit if you want an IUD (intrauterine device), a birth control implant, or sterilization.
HeyDoctor, which was recently purchased by GoodRx, offers birth control visits for $20 without insurance, says Brendan Levy, M.D., chief medical officer of HeyDoctor. You will tele-visit with a nurse, a doctor, or another licensed healthcare professional, who should get a detailed medical history and be able to write a prescription that’s then transferred to a local pharmacy or even shipped directly to your house.
Nurx charges $15 for an online appointment with a healthcare professional—follow-up appointments are free—and the company says many of its birth control pills run about $15 for a month’s supply without insurance. See this page for details on where Nurx operates (currently 29 states and the District of Columbia).
Another site, called Hers, charges $30 per month for an online doctor visit and any of these 10 birth-control options sent to your door as part of the monthly fee. Follow-up visits cost $5.
Read more about online healthcare visits and how to protect your privacy during a televisit.
Federally funded health clinics: For in-person visits, you could look for a federally qualified health center. These clinics usually provide care on a sliding scale. There more than 12,000 centers across the U.S., but some clinics might not offer birth control and family planning options, partially because of cuts in federal funding, so find a clinic near you and call ahead to confirm which services they cover.
Planned Parenthood: At more than 100 years old, Planned Parenthood is one of the oldest reproductive and sexual health and wellness organizations in the U.S. It offers a range of birth control services, along with help finding affordable options, “no matter what your circumstances are,” says Gillian Dean, senior director of medical services for the Planned Parenthood Federation of America. She says that some Planned Parenthood offices charge based on income. Look up clinics near you and make appointments online.
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