Condoms are now covered by the ACA: Who knew?

A small, almost silent, step towards equality in contraceptive coverage between men and women

I’m weedily deep into some research on preventive health care coverage. It’s for a forthcoming policy paper out of the American Institute for Boys and Men. If you’ve not signed up for our newsletter, do it now! Thank you!

I’m trying to figure out how best to correct the gender imbalance in preventive health coverage that has led, for example, to anxiety screening being covered for women and adolescent girls, but not for boys and men. More soon on all that. . .

As part of the project I’m looking at contraceptive coverage. A few years back, I discovered that female sterilization (tubal ligation) was covered without cost under the ACA, but male sterilization (vasectomy) was not. Even though it is cheaper, safer and more effective. I wrote a short paper for Brookings on the subject, but for a deeper dive into the policy distortions on this issue, I recommend this paper by Adam Sonfield at the Guttmacher Institute.

When the Affordable Care Act (ACA), or Obamacare, was passed, recommendations on contraception were delegated to the Women’s Preventive Services Initiative. It was made clear that male contraception did not count as “women’s” preventive health care, even though it does in fact stop women getting pregnant. When the ACA was passed, the official guidance was explicit, referring to “female-controlled” contraceptives. And in a footnote to the ACA guidance in the Federal Register, the point was spelled out. Contraceptive coverage would “exclude services relating to a man’s reproductive capacity, such as vasectomies and condoms.”

But that has changed. Condoms are now covered by the ACA. If you didn’t know that, you’re not alone. The change was made so quietly that it was barely a whisper. There were no trumpets sounding from the roof of the Department for Health and Human Services. There was no media blitz. Strikingly a letter to health insurers from the administration in June 2022 on the specific subject of contraceptive coverage made no mention of the change, when it seems like that would have been a good communication opportunity.

This is, in fact, virtually breaking news. Here’s how it happened.

In 2021, new recommendations from the Women’s Preventive Services Initiative (WPSI), which has contracted with the American College of Obstetricians and Gynecologistsi (ACOG), included removing the important term “female-controlled” from the contraceptive mandate, and the removal of “female” as a prefix to “condom”.

The goal was clear, as the Federal Register report shows:

This is a clear break from the original ACA mandate. Male condoms now count as preventive health care! This is, like, news. Good news, too.

These recommendations are not automatically covered under the ACA. They first have to be accepted by the HRSA. But at the end of 2021, they were, with the announcement coming in January 2022:

ACOG reiterated the implications of the recommendation in its own release on HRSA’s adoption:

To be clear, the rules about condoms are the same as for the other forms of contraception: only women can get them covered, and only then with a prescription. (There’s a whole push around over-the-counter contraception and the ACA, but for now that’s the way the law works).

The fact that men can’t get condoms (or vasectomies) under the ACA is a bizarre side-effect of the general asymmetry in preventive heath care coverage. But that’s for another day (specifically, the day I publish the paper that I’m taking a break from to write this).

But I’m really struck by the almost complete lack of awareness that condoms are now covered without cost-sharing by the ACA. It honestly seems to have passed almost everyone by, with a couple of honorable exceptions:

• Lauren Wallace, Senior Counsel for Reproductive Rights and Health at the National Women’s Law Center, discussed the new coverage in a blog post, “2023 & Free: You May Never Have to Pay for Condoms Again!” that accurately described the recent changes.

• Sowmya Kuriganti of The Association of State and Territorial Health Officials in her article, “Understanding the Updated Women’s Preventive Services Guidelines” .

But otherwise, nobody knows. Like, nobody.

WebMD doesn’t know:

Healthinsurance.org doesn’t know (even in January 2024):

Verywell health doesn’t know:

Even Planned Parenthood doesn’t know!

But health insurance plans are now required to cover the cost of condoms under the revised rules. Or at least that’s my reading. I take comfort from the opinion of lawyer Lauren Wallace at the NWLC, but I’m also naturally nervous to state that Planned Parenthood is mistaken about contraceptive coverage under the ACA!

Assuming Wallace and I are right, I’m sympathetic to the lack of awareness. After all, the change was made stealthily. There may well be political reasons why the Biden Administration does not want this change to be widely known. Perhaps there’s a fear it will be used as an argument against the ACA.

But it seems to me that this is a lost opportunity. This is a step towards encouraging couples to rebalance contraceptive responsibility. Especially given the rates of unintended pregnancies and STIs, this change should surely be a cause for celebration.

The way that it came about, through the women’s preventive health infrastructure, also highlights the need to revisit the absence of male health in the ACA’s preventive health care provisions. On that front, do watch this space.