Are health plans required to cover male contraception?
No, unless it’s a state-regulated health plan and the state requires coverage for male contraception. Although female contraception, including sterilization surgery, must be covered without cost-sharing by non-grandfathered health plans under the ACA’s preventive coverage guidelines, the coverage requirement does not include contraceptive methods for men.
The Women’s Preventive Services Guidelines include all FDA-approved methods of contraception for women, which means that insurers have to cover at least one type of each method at no cost to the member. But there is no federal requirement that insurers pay for FDA-approved contraceptives for men.
Are condoms covered by the ACA's preventive health services coverage mandate?
Virtually all of the FDA-approved methods of contraception apply to women. The only exceptions are condoms and vasectomies. Female condoms are covered under the ACA’s preventive care rules if they’re prescribed by a doctor. But there is no federal rule requiring insurers to cover male condoms (condoms are purchased over the counter and don’t require a prescription).
Are health plans required to cover vasectomies under the ACA's preventive health services coverage mandate?
Some health plans do cover all or part of the cost of a vasectomy, but they are not required to do so under federal rules. Although female sterilization (which costs much more than a vasectomy) has to be covered in full by non-grandfathered health plans, the same is not true for male sterilization.
Some states have enacted laws requiring state-regulated health plans to fully cover the cost of vasectomies, but state laws do not apply to self-insured health plans, which account for the majority of employer-sponsored health plans. (Rhode Island might be the latest state to adopt a rule requiring state-regulated health plans to cover all types of FDA-approved contraception, including vasectomies and male condoms; that will be the case if H.5477 is enacted during the 2023 legislative session.)