Birth control's big 'cost control' gains from Obamacare

American women are spending significantly less money out of pocket on contraception because of the Affordable Care Act—and are on track to spend even less in coming years, according to a new report.

Women with private health insurance who used an oral birth control pill saved an average of about $255 annually in out-of-pocket costs after the implementation of Obamacare, the study published Tuesday in the journal Health Affairs found.

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Overall, American women spent roughly $1.3 billion less in out-of-pocket costs on the pill alone in 2013 as a result of the ACA, the study suggests.

And the out-of-pocket savings for a privately insured woman using an intrauterine device (IUD) was an average of $248, according to the study, which tracked spending by more than 790,000 women of child-bearing years through June 2013.

Birth control pills
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Obamacare as of August 2012 has mandated that insurance plans not impose copayments, coinsurance expenditures or other cost-sharing requirements on women when they obtain birth control. Instead, the plan is required to fully cover the costs of contraception.

However, a sizable minority of privately insured people were in plans grandfathered under Obamacare in 2013. Those plans thus are not subject to the mandate barring out-of-pocket birth control spending.

So, "while some women were still paying large amounts out of pocket for their contraception, the majority of women were paying nothing by June 2013," the report said.

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And because the grandfathered plans since 2013 are being phased out, and replaced by ACA-compliant plans, even fewer women will be paying anything out of pocket for birth control in coming years, leading to greater savings overall.

"This paper finds some very dramatic impacts despite the fact that the law isn't fully implemented yet," said Nora Becker, one of the authors of the Health Affairs study, and a MD/PhD candidate at the Wharton School at the University of Pennsylvania.

One impact which Becker cited was the sharp reduction in women's overall out-of-pocket spending on health care. Before the ACA, she said, women were spending between 30 and 44 percent of their total out-of-pocket health costs just on birth control.

That said, insurance plans can theoretically recoup the costs from having to cover birth control 100 percent by increasing the monthly premiums they charge customers. However, Becker noted that contraception can actually save insurance plans money because it reduces the incidence of costly pregnancies and child deliveries.

Becker said it remains to be seen whether the reduction in out-of-pocket-related costs will change women's choice or usage of birth control methods. For example, the removal of a relatively large upfront cost of an IUD could lead more women to adopt that device, which lasts three to 10 years, she said.

"There's room to grow, basically, for women in the United States to use birth control," Becker said. "This out-of-pocket change could potentially increase birth control use."

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"While most women are using some form of contraception or do so at some point during their lifetime," she said, "only about 30 to 40 percent of women are actively using prescription contraception at a given time."