Contraceptive coverage has increased under an Obamacare mandate, but most private health insurers still do not cover all forms of contraceptives without some form of cost-sharing or limitations, according to a report from the Kaiser Family Foundation.
Beginning in August 2013, the Affordable Care Act required most private plans to provide coverage for women's health care without cost-sharing, including all FDA-approved contraceptive services and supplies. Although there have been anecdotal reports of women being unable to secure coverage, the Kaiser report was the first time that plan coverage of contraceptives has been studied.
"It really is a game changer for women. But we also hear from women every day who are having trouble getting the benefit," said Gretchen Borchelt, a vice president at the National Women's Law Center.
The report collected information from 20 carriers in five states, although the carriers were national and most likely have the same plans across locations and both within and outside of exchanges.
"Because contraception is so common, most of the plans make coverage decisions across all their lines of coverage," said Alina Salganicoff, the vice president and director of women's health policy at Kaiser.
Some contraceptive methods - particularly the vaginal ring, the patch and implants - are limited by plans more often than others, according to the report. It can also be difficult for women to determine which contraceptive forms are covered under their plan.
Despite national attention to religious accommodations, insurers reported they have received few requests for an accommodation from employers with an objection to contraceptive coverage because of their religious affiliation.
Borchelt said that regulators need to step up enforcement of the law and to offer further guidance as to its implementation.
"These are violations of the law. These plans are violating the Affordable Care Act. They need to come into compliance," she said.
In response to the report, HHS emailed a statement saying that it "strongly supports ensuring that women can access contraceptive services."
"We appreciate the importance of this issue and plan to release more guidance soon," spokeswoman Katie Hill wrote.
This story has been updated.
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Caitlin Owens is a health care reporter at National Journal. Her work has previously appeared in the Los Angeles Times, The News & Observer and The Charlotte Observer. She is a graduate of the University of North Carolina at Chapel Hill.