Are women benefiting from the Affordable Care Act? A real-world evaluation of the impact of the Affordable Care Act on out-of-pocket costs for contraceptives



      The Affordable Care Act (ACA) mandated that, starting between August 1, 2012 and July 31, 2013, health plans cover most Food and Drug Administration (FDA)-approved contraceptive methods for women without cost sharing. This study examined the impact of the ACA on out-of-pocket expenses for contraceptives.

      Study design

      Women (ages 15–44 years) with claims for any contraceptives in years 2011, 2012 and 2013 were identified from the MarketScan Commercial database. The proportions of women using contraceptives [including permanent contraceptives (PCs) and non-PCs: oral contraceptives (OCs), injectables, patches, rings, implants and intrauterine devices (IUDs)] in study years were determined, as well as changes in out-of-pocket expenses for contraceptives during 2011–2013. Demographics, including age, U.S. geographic region of residence and health plan type, were also evaluated.


      The number of women identified with any contraceptive usage in 2011 was 2,447,316 (mean age: 27.6 years), in 2012 was 2,515,296 (mean age: 27.4 years) and in 2013 was 2,243,253 (mean age: 27.4 years). In 2011, 2012 and 2013, the proportions of women with any contraceptive usage were 26.3%, 26.2% and 26.9%, respectively. Over the three study years, mean total out-of-pocket expenses for PCs and non-PCs decreased from $298 to $82 and from $94 to $30, respectively. For non-PCs, mean total out-of-pocket expenses for OCs and IUDs decreased from $86 to $26 and from $83 to $20.


      Implementation of the ACA has saved women a substantial amount in out-of-pocket expenses for contraceptives.


      Mean total out-of-pocket expenses for FDA-approved contraceptives decreased approximately 70% from 2011 to 2013. Implementation of the ACA has saved women a substantial amount in out-of-pocket expenses for contraceptives. Longer-term studies, including clinical outcomes, are warranted.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Contraception
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


      1. U.S. Department of Health and Human Services. Women's Preventive Services Guidelines. Washington, D.C. Available from: [Accessed March 30, 2015].

        • Federal Register
        Rules and Regulations.
        in: 54.9815-2713 Coverage of preventive health services. 2013 ([Vol 78, No. 127, Available from: Accessed March 30, 2015])
        • Institute of Medicine
        Clinical Preventive Services for Women: Closing the Gaps.
        Date: 2011
        (Available from:) ([Accessed March 30, 2015])
        • IMS Institute for Healthcare Informatics
        Medicine Use and Shifting Costs of Healthcare.
        in: Report by the IMS Institute for Healthcare Informatics. 2014 ([Parsippany, NJ]. Available from:) ([Accessed March 30, 2015])
        • Burke A.
        • Simmons A.
        • Office of The Assistant Secretary for Planning and Evaluation
        Issue Brief.
        in: Increased Coverage of Preventive Services with Zero Cost Sharing Under the Affordable Care Act. U.S. Department of Health & Human Services, Washington D.C.2014 ([Available from: Accessed March 30, 2015])
        • Becker N.V.
        • Polsky D.
        Women saw large decrease in out-of-pocket spending for contraceptives after ACA mandate removed cost sharing.
        Health Aff. 2015; 34: 1204-1211
        • Bearak J.M.
        • Finer L.B.
        • Jerman J.
        • Kavanaugh M.L.
        Changes in out-of-pocket costs for hormonal IUDs after implementation of the Affordable Care Act: an analysis of insurance benefit inquiries.
        Contraception. 2016; 93: 139-144
        • Sonfield A.
        • Tapales A.
        • Jones R.K.
        • Finer L.B.
        Impact of the federal contraceptive coverage guarantee on out-of-pocket payments for contraceptives: 2014 update.
        Contraception. 2015; 91: 44-48
        • Mosher W.D.
        • Jones J.
        Use of contraception in the United States: 1982–2008. National Center for Health Statistics.
        Vital Health Stat 23. 2010; : 1-44
        • Finer L.B.
        • Jerman J.
        • Kavanaugh M.L.
        Changes in use of long-acting contraceptive methods in the United States, 2007–2009.
        Fertil Steril. 2012; 98: 893-897
        • Finer L.B.
        • Zolna M.
        Unintended pregnancy in the United States: incidence and disparities, 2006.
        Contraception. 2011; 85: 478-485
        • Trussell J.
        • Henry N.
        • Hassan F.
        • Prezioso A.
        • Law A.
        • Filonenko A.
        Burden of unintended pregnancy in the United States: potential savings with increased use of long-acting reversible contraception.
        Contraception. 2012; 87: 154-161
        • Mehta P.
        Addressing reproductive health disparities as a healthcare management priority: pursuing equity in the era of the Affordable Care Act.
        Curr Opin Obstet Gynecol. 2014; 26: 531-538
        • Kaiser Family Foundation
        • The Lewin Group
        Coverage of contraceptive services: a review of health insurance plans in five states. Menlo Park, CA.
        Date: 2015
        (Available from:) ([Accessed March 30, 2015])