Free Birth Control, $2,097 a Year
The Affordable Care Act has guaranteed birth control at no cost since 2012. More than a decade later, women are paying an average of $2,097 a year for it, according to a new report from the National Women’s Law Center.
The report draws on more than 8,500 requests to the group’s CoverHer hotline since 2013. Insurers are excluding whole categories of contraception from their plans, refusing to cover related care like office visits and surgical anesthesia for sterilization, and requiring women to try and fail other methods before covering their preferred option, a practice the group calls unlawful under the ACA mandate.
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Since the Dobbs decision, the pattern has shifted. By 2025, 55% of hotline requests involved coverage for removal of both fallopian tubes, a permanent option more women are now seeking.
The ACA’s contraceptive mandate requires most private health plans to cover all FDA-approved contraceptive methods without cost-sharing. Coverage denials are following women into the permanent options too: bilateral salpingectomy, the surgical removal of both fallopian tubes, is increasingly being requested and increasingly being denied or obstructed by the same mechanisms the NWLC has documented for years.
The law has not changed. What the report documents is a sustained pattern of workarounds, and a gap between what the mandate requires and what women are actually experiencing at the point of care.