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Does Obamacare cover sterilization?

A brief overview...
  • Under the Affordable Care Act, most health insurance plans have to cover at least one type of female sterilization procedure
  • Sterilization surgery and surgical sterilization implants are 2 of the 18 types of contraception coverage that must be covered
  • Insurance plans are not required to cover any surgeries that affect a man’s reproductive ability, including male sterilization procedures such as vasectomies

What is sterilization?

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Sterilization is a permanent procedure performed on the reproductive organs in an effort to prevent future pregnancies. There are male and female sterilization procedures.

The Affordable Care Act only requires insurance companies to cover female sterilization procedures but not vasectomies for men. Female sterilization can be surgical or nonsurgical. Surgical sterilization for women is known as a tubal ligation procedure and works by cutting or sealing the fallopian tubes.

Nonsurgical sterilization works by implanting devices into the fallopian tubes to close them. They are implanted into the vagina and uterus and do not require a laparoscopy surgery or an incision in the same way a tubal ligation procedure does. Nonsurgical sterilization is not immediately effective so be sure to follow up with your doctor.

Female surgical sterilization is close to 100 percent effective in preventing pregnancy. However, it does not protect against sexually transmitted infections. Nonsurgical sterilization is slightly less effective, especially in the very beginning. It is difficult to reverse this procedure and it often does not work so it is not a good idea for you if you wish to have a child at some point in the future.

Male sterilization works by cutting, tying, or blocking the vas deferens, which are the two tubes that carry the sperm to the penis. Vasectomies can be performed under local anesthesia and serious complications are unlikely to occur after. They are generally less expensive than tubal ligation procedures if you are paying out of pocket, although they are not required to be covered by health insurance plans.

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Are sterilization procedures free under the Affordable Care Act?

Health insurance plans that you purchased in the healthcare exchange marketplace are required to cover contraception and counseling for women, when prescribed by a medical provider, without charging any out of pocket costs, including copayments and other coinsurance charges.

These services must be covered even if you haven’t met your deductible yet. Surgical and nonsurgical female sterilization procedures are both covered under this provision.

What are the 18 types of contraception?

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There are 18 types of contraception that the Affordable Care Act requires health insurance plans to cover free of cost. However, plans must cover only one type of birth control from each of these 18 categories.

In addition to sterilization procedures, health plans must cover implantable rods, copper intrauterine devices, intrauterine devices that contain the hormone progestin, birth control shots or injections, three different types of oral contraceptives, a diaphragm, a sponge, the patch, a vaginal contraceptive ring, a cervical cap, a female condom, spermicide, and two emergency contraceptive types including the plan B pill and the Ella pill.

Health insurance plans will usually cover the generic brand of each of these types of contraceptives unless a name brand version is considered a medical necessity.

Are there exceptions to the birth control mandate?

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There are some exceptions to this requirement under the Affordable Care Act. Plans that were grandfathered in do not have to comply with all of the Affordable Care Act guidelines. These include plans that were purchased prior to March 23, 2010. Short term health insurance plans typically do not cover most of these contraceptives and some alternative plans do not provide coverage for birth control that is considered controversial.

If you get your health insurance through a religious employer, contraceptives may not be covered directly. In most cases, employees of exempt religious employers, including non-profit hospitals and higher education institutes that are affiliated with a religion, are eligible for birth control coverage through a third party administrator. However, not all non-profit institutions have to arrange for this third party coverage. This does not stop you from arranging it yourself.

If you work for a house of worship, such as a church or a temple, your employer does not have to provide you with contraceptive coverage at all.

They are exempt from the rule that requires most religious employers to arrange for birth control coverage for their employees through a third party administrator. In this case, you will most likely have to pay for these services out of pocket.

Does Obamacare cover sterilization?

Most health insurance plans, including ones that are purchased on the Healthcare Exchange Marketplace website, cover female sterilization completely without any out-of-pocket charges. Male sterilization procedures are not covered. Some plans might be exempt from the requirement to provide this coverage.

Click here to compare free private health insurance quotes and various birth control coverage options.

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