by Sierra Dole
For years, a woman with health insurance seeking preventative care needed to schedule a visit with her physician or a specialist, pay a co-pay and then pay what the insurance did not cover for any prescriptions. Now, there’s good news for these women. All health care plans that are not grandfathered out of doing so will now cover preventive health care, and women will not need to pay co-pays, deductibles or out-of-pocket fees. Grandfathered health plans include plans that have covered at least one person continuously from before March 23, 2010.
According to the Understanding Health Reform website, preventative care, such as well-woman visits, screening for gestational diabetes, HPV testing, counseling/screening for STIs/HIV, contraceptive methods and counseling, breastfeeding support, supplies, and counseling, and screening and counseling for interpersonal domestic violence.
Religious employers and organizations who meet the legal requirements, however, may be exempt. According to the Understanding Health Reform website, nonprofit religious employers and “religious organizations such as hospitals, schools, and social service agencies, which do not offer contraceptive benefits” may be exempt from offering contraceptive coverage (including sterilization procedures).
University care
For Penn State students with ETNA Student Insurance who seek preventative care, the process is easier than ever.
“We have, I think I would say, all FDA approved birth control options available short of sterilization at the Health Services,” said Jill Buchanan, a clinician at University Health Services (UHS). “As far as insurance coverage…if you have the ETNA Student Insurance policy, then that’s going to cover services here. If you have other types of insurance, it depends on your insurance whether or not they’re going to cover services.”
According to Buchanan, students can find more information about the different forms of birth control at studentaffairs.psu.edu/health, by clicking on ‘health info’ and scrolling down to ‘birth control,’ or by calling and making an appointment to speak to a clinician.
“Our most popular method is birth control pills and that requires a prescription,” Buchanan said. “So does the vaginal ring or the patch. We don’t require an exam to provide that. …the pharmacy here does accept many prescription pharmacy plans, and [the pharmacist] could let a person know if they accept it or not if.”
“I think what [the mandate] is going to do is open up and broaden the sense of what an individual thinks are options for them,” Buchanan said. “So…if [patients] have been thinking about the pill because it’s as cheap as $10 a pack, but they’ve got to take it every day, they’ve got to remember to take it, they have to refill it, but it sounds affordable. Now, they can think, “maybe I can get a Mirena, an intrauterine system, and once it’s in, it’s protecting me for 5 years and I don’t have to remember it every day…”.”
According to Buchanan, clinicians at UHS are seeing a rise in intrauterine device (IUD) requests.
“The more long acting reversible methods, we’re definitely seeing a trend towards those,” Buchanan said. “I think when you remove the money up-front barrier, which is almost $500-700, then probably people are going to see themselves as candidates for those more effective methods, because now they can afford them because their insurance will cover it.”
Statistically, IUDs are more effective birth control. Buchanan said that IUDs are 99 percent effective, whereas the pill is only 98 percent effective for perfect users and 86 percent effective for typical users who tend to forget to take it. So making IUDs more affordable puts more effective birth control in the hands of more women.
No cost barriers to care
Non-students seeking preventative care can visit Tapestry of Health.
“The services we provide are many forms of oral contraception, what they call LARCS (Long Acting Reversible Contraception), and what those are are IUDs, Nexplanon, that’s the one that goes in the arm, and we also do the Depo shot,” said Rachel Fetzer, Tapestry of Health clinical director.
Like UHS, Tapestry of Health provides services for little or no cost to the women who need them.
“We have a sliding fee scale based on their income and we also help get them enrolled in medical assistance or Select Plan for Women, which is a Pennsylvania program for women who are over the federal poverty level up to 185 percent,” Fetzer said. “And if they’re not eligible for MA [Medical Assistance], Select Plan for Women will cover all of their reproductive health exams and birth control. We also bill many private insurance companies.”
According to Fetzer, there are no barriers to service at Tapestry of Health.
“LARCS [Long Acting Reversible Contraceptions] are costly to have on hand, but when a patient sees us, we talk about all forms of birth control, and if they’re interested in an IUD, then we schedule them for that,” Fetzer said. “We schedule maybe a month out and we get it on hand and then we have the device for the patient and we get it done. That’s the business we’re in, we’re in trying to make sure that people have access to the care and the resources that they want and need.”
Fetzer also stated that the clinic is always accepting new patients at any of their four offices.
“We’re very encouraged that women’s health is climbing on the priority list of rights and abilities to not have any further barriers to keep us from seeking medical attention on preventative care,” Fetzer said. “We see about 4,100 patients a year and there’s more out there who don’t know we’re here.”
Fetzer said she is encouraged that the health care reform has included both birth control and preventative care services for no additional cost to women.
“We’re very much thrilled that, not only birth control, but that women’s preventative medicine will not incur any copays,” Fetzer said. “We do a lot of annual exams for women if they don’t have insurance, and we identify a lot of times any risks or abnormalities that would have gone unfound. I think, too, that even if women do have health insurance and they have a $20 copay, they might not choose to go for their annual because…they might not have that $20 that week.”
According to Fetzer, cancerous abnormalities are very treatable if found early during exams.
Contraceptive education
Gina Secura, director for the Choice Project based out of the Washington University School of Medicine in St. Louis, said that removing the cost barrier to preventative care certainly helps, but that it’s not the only barrier that needs addressed.
“It’s not just about cost,” Secura said. “That’s one big piece, but another big piece is most women don’t know about all of their options. They know about the pill, they might know about Depo, but unless they’re educated about all of the methods so they can figure out what method best fits them, then you’re not necessarily going to have the uptake of some of the more effective methods.”
According to Fetzer, education isn’t a problem at Tapestry of Health.
“It’s very much a two-way conversation to talk about all methods that are available and we continue with birth control consultation while we have our patients on different methods because circumstances change, their likes and dislikes change depending upon the method,” Fetzer said. “Birth control isn’t a once-and-done decided choice, it’s an ongoing discussion of how it’s working for you and your partner and you keep that conversation going with your provider.”
According to Secura, women also typically experience problems with gaining access to different contraceptive methods.
“Traditionally, women learn about contraception from their OB-GYN, their family practitioner, or nurse practitioner,” Secura said. “And because that visit is so short, and you end up talking about a lot of things, what has historically been the case is they’ll say ‘what did you use in the past?’ or ‘what are you interested in?” and she’ll say ‘well, my girlfriend’s on the pill’ or ‘my mom said the pill’ and they’ll go ‘great! I’ll give you a prescription’ and there’s just no opportunity to have a longer conversation around all of the methods. We [society] do a…really lousy job educating half of the population about something that they spend 30 years or more worried about.”
Secura also said access to IUDs can be limited because stocking the devices is too expensive for many clinics. Instead of putting thousands of dollars into stocking methods, most clinics try to put patients on different contraceptive methods which are cheaper to prescribe. However, participants of the Choice Project who were given the IUD option demonstrated decreased unintended pregnancy rates, which were down 70 percent compared to national statistics.
“We thought that we could double the use of IUDs in the cohort nationally from 5 percent to 10 percent,” Secura said. “And so, to find out that 50-55 percent chose an IUD was shocking. Now they use them longer than women choosing other methods. And we showed that there is no difference in continuation by age. If women are using effective contraception, you’re going to see fewer unintended pregnancies.”
Secura said that while she believes the reform is a step in the right direction, there’s more that needs to be done.
“I think [the reform] is absolutely going to be helpful,” Secura said. “But, I think these other two pieces have to be figured out. In California, there’s the California Pact Program, which provides free contraception to low income women. And if you compare our LARC uptake to theirs, theirs is at about 10-15 percent. And we’re getting calls from them saying ‘what are you guys doing? We removed the cost barrier and we’re not seeing 75 percent uptake.’ And I think it’s because it’s the education piece and because of the access piece.”