North by Northwestern

I am a 20-year-old female college student waiting in line at CVS to pick up my prescription. I tell the pharmacist my name, wait for her to process my script and hand over my goodie bag, a one-month’s dose of Ortho Tri-Cyclen Lo, or in layman’s terms, birth control.

I’ve repeated this process every month since I was fifteen. Switching from pill to pill depending on which one my insurance policy at the time decided to cover, I’ve put my body and my bank account through hell over the past five years. This month, with a new prescription, insurance policy and Obamacare in the back of my mind, I was hopeful that I wouldn’t have to suffer hormonally or financially.

I was wrong. The pharmacist tells me to swipe my card. I see the charge for $150 and recoil. I can’t afford that.

“Well, a baby would be more expensive,” she tells me, as if the comfort of knowing I won’t have to soothe a baby’s tears will stop my own as I wave goodbye to half my paycheck.

In 2012, the Center for American Progress found that 55 percent of women between the ages of 18 and 34 struggled to cover the cost of preventative care, leading to inconsistent use, and in one-third of these cases, unexpected pregnancies.

With the passage of the Affordable Care Act in 2010, many private health insurance companies began to offer birth control and other preventative services without co-pays or deductibles. Some insurance plans are offering this coverage now; others will slowly implement this policy in coming years. Nearly 27 million women have benefitted from this policy according to the National Women’s Law Center, though there are still some challenges women face when trying to procure free contraception.

Before the passage of the ACA, insurance companies typically only covered a portion of the cost of birth control, with the patient paying the rest out of pocket with co-pay.

According to National Women’s Law Center, insurance companies are now required by the law to cover the full cost of preventative measures, covered by the monthly premium consumers already pay. According to ThisIsPersonal.org, a non-profit organization geared toward protecting women’s reproductive rights, opponents of birth control have filed over 70 lawsuits to challenge the requirement of insurance companies to provide birth control without co-pay. Their arguments are primarily that the “government” shouldn’t have to pay more for women to be able to have sex “without the consequences.”

It’s not the government’s money at all, however. The cost of coverage still comes from the consumer’s insurance payment each month. And the cost of one pack of oral contraceptive (the pill), an IUD or a diaphragm is without a doubt lower than maternity, infant and dependent care, with the cost to the insurance companies of providing family planning services more than making up for itself in the expected cost savings, according to the National Business Group on Health. My pharmacist was right about that – babies are very expensive.

Additionally, more than half of all birth control pill users don’t see the pill solely as a “get-out-of-pregnancy-free” card. Fifty-eight percent of women on the pill cite non-contraceptive reasons for using it, like excessive menstrual pain, bleeding and endometriosis, according to ThisIsPersonal.org. When I got on the pill at fifteen I was more worried about not having to leave school with a “stomachache” again than I was about getting knocked up.

If your insurance (or your parents’) has not changed since the passage of the ACA, your provider does not have to adhere to this new policy, with about half of most insurance plans still falling into this “grandfather clause,” or using the terms initially agreed upon when your plan was purchased, at the end of 2013.

Insurance companies can also pick and choose which pills to cover, denying coverage of most pills with a generic alternative and some not at all, forcing women like myself to not only spend many frustrated hours screaming on the phone with an insurance representative (sorry, guy, but you messed with my hormones) but also throw our bodies completely out of whack with each change in prescription. In my freshman year alone, I changed prescriptions five times. I practically lived at CVS on the last Sunday of every month.

So where does this leave us and what can we do to avoid the headache that isn’t from a hormone imbalance?

If you’re unsure whether or not you could qualify for free birth control, the easiest way to find out (and see which pills are covered by your insurance company) is simply to call. The National Woman’s Law Center provides scripts for how to go about addressing these questions with your insurance provider and how to find a plan that best suits your birth control needs.

Every insurance company must cover at least one form of each birth control method and your doctor should work with you to find not only a form and brand that works best for your body, but also what your insurance will cover. Switching methods (from pill to IUD, for example) might be best suited for some, while others may be able to go generic to save themselves money at the pharmacy counter.

Planned Parenthood is still a provider of birth control under most insurance plans. They provide a nifty site where you can simply enter your zip code and see which insurance providers will allow you to get free birth control from that location.

If you go into your doctor already knowing what your insurance will cover, you can narrow down your options with their guidance and walk out without the uncertainty that accompanies the guessing game when filling a new script.