Reproductive Healthcare

In addition to providing general healthcare, all marketplace health plans must cover additional reproductive health services. These services include not only contraceptive services and sexually transmitted infection (STI) screening and treatment, but also screening tests for breast, cervical, and colon cancer, screening for intimate partner violence and support for breastfeeding to name a few. These services must be covered regardless of your gender identity, sex assigned at birth, or recorded gender. These plans must also cover preventive services without charging you a copayment or coinsurance, even if you haven't met your yearly deductible.

Plans are not required to cover contraceptive services for men, like vasectomies, so it is useful to ask specific questions about these services. For a complete list of trans-specific questions, please see the section called Transgender Related Healthcare.

  1. Contraception: Annual exams and all methods of contraception that have been approved for sale in the United States (in­cluding barrier and hormonal methods, such as rings, pills, patches, and implants, as well as IUDs and sterilization/tubal ligation for women) are now covered without a co-pay, co-insurance, or a deductible when they are prescribed by a clinician and provided by an in-network provider. Even with changes you may have read about under the Trump administration, this continues to be true for marketplace plans and your contracep­tion should be covered. However, your plan might charge a co-pay for some specific brands of contraception if a generic version is available.
    1. I prefer to use X brand of birth control. Is there a co-pay for this brand of contraception?
    2. Is vasectomy covered under this plan as a form of birth control? What kind of pre-approval does a vasectomy need? If vasectomy is not covered, what are the out-of-pocket expenses?
  1. Clinicians: You may prefer to see a nurse midwife, nurse practitioner, family doctor, or other clinician for your reproductive healthcare instead of an OB/GYN.
    1. I would like to keep my current reproductive healthcare provider. Are they covered on this plan?
    2. (OR) I prefer to see a midwife or other clinician for my OB/GYN care. How big is the network of providers?
  2. Fertility Coverage: Does the plan include fertility coverage? If so, what kinds of services (IUI, IVF, surrogacy, medications, and other assisted reproductive technologies) are covered? If the plan includes fertility coverage, be aware that some plans require a waiting period of six to twelve months, depending on the age of the patient, and the following questions may help:
    1. Is there a waiting period before assisted reproductive technology (ART) services are covered?
    2. Do I have to have a condition of infertility to qualify for ART services? Do I have to have attempted to inseminate or get pregnant without success prior to being covered for ART services?
    3. Are ART services provided to single individuals? Are ART services provided to same-sex couples or couples where one or both of us are transgender? Do couples have to be legally married to be covered for ART services?
  3. If the plan I purchase now does not include fertility coverage and I want to purchase coverage for fertility options, how and when may I change plans in the future?
  4. Surrogacy: Maternity and newborn care is considered an essential health benefit that must be covered by any insurance plan offered in state marketplaces. Therefore, pregnancy—regardless of how or why a woman becomes pregnant—should ALWAYS be covered.
    1. If I hire a surrogate, can I cover that surrogate on my health plan?
  5. Birthing: Will the plan cover home birth or birth at an out-of-hospital birth center? Is there a co-pay for out-of-hospital or home birth care?
    1. Does the plan provide coverage for birth assistants or doulas?
  6. Breastfeeding support and coverage: Health insurance plans are required to cover the cost of a breast pump. Plans may offer to cover either a rental or a new one for you to keep. Plans may provide guidance on whether the covered pump is manual or electric, how long the coverage of rented pumps lasts, and when they'll provide the pump (before or after you have the baby).
    1. What's the coverage for a breast pump – is it a rental or is it purchased? What's the co-pay for a pump?
    2. Is hormone or lactation therapy covered if a non-birth parent is trying to induce lactation?
    3. Are there LGBT lactation or trans-friendly lactation consultants available on this plan?
  7. What is included in coverage for post-natal care?
  8. Does this plan cover abortion services?
    1. What out-of-pocket expenses would I be responsible for if I choose, or someone covered by the plan chooses, to have an abortion?
    2. Is medication to induce a non-surgical abortion covered on the plan? If not, what is the co-pay?
    3. How is billing handled for abortion services? Is abortion listed on the bill?
  9. I might want to preserve my future fertility by storing eggs and/or sperm. Is fertility preservation (egg or sperm capture, storage, freezing, etc.) covered under this plan?
    1. Is egg harvesting covered in this plan? What is the co-pay for egg harvesting?
    2. Is ongoing storage covered under this plan or is it the individual's responsibility?
    3. If I am transgender and obtaining transition-related care that will make me infertile, is there coverage for retrieving and storing my eggs/sperm?
    4. To get a hysterectomy, what kind of medical approval or clearance do I need? Will I incur any out-of-pocket expenses?

Questions in red are ones that assisters may not be able to answer because this kind of information is not gathered consistently from healthcare providers. However, we included them because we know that these kinds of questions can make a critical difference in creating a trusted relationship with your healthcare provider.