How insurance coverage impacts contraception use

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According to a recent study published in AJOG Public Reports, there are notable disparities in contraception use based on insurance coverage.

Medicaid and Medicare have notable variations in their coverages for contraception, despite being the 2 largest public payers in the United States. The Affordable Care Act required Medicaid to cover a full range of contraception options without having the enrollee pay any part of the cost.

Medicare offers insurance coverage for patients aged over 65 years, as well as younger patients with disabilities or end-stage renal disease. However, these programs are exempt from mandated contraceptive coverage under the Affordable Care Act. 

Medicare must decline contraceptive claims which aren’t covered, and Medicaid will only cover them for dual-eligible patients. Medicare Part A and B will rarely fully pay for contraceptive claims, often only covering oral contraceptives for endometriosis and similar conditions.

Investigators conducted a study to compare the use of various contraceptive methods among dual-eligible women compared to those only enrolled in Medicaid. Contraceptive use based on dual-eligibility status was determined using the 2016 Medicaid T-MSIS Analytic Files, while comparisons between study groups were made using the Office of Population Affairs metric.

Participants included female patients aged 15 to 44 years with a Medicaid enrollment and no procedure codes for infecundity in 2016. Patients were grouped based on having dual coverage or Medicaid only, with the dual coverage group divided based on full Medicaid and Medicare coverage or partial coverage.

Long-acting reversible contraceptive (LARC) use was estimated, as well as the rate of most effective or moderately effective contraceptive use. Effect contraceptive methods included contraceptive implants, sterilization, injectables, intrauterine devices, patch, oral pills, ring, and diaphragm.

There were 11,129,239 participants included in the final analysis, 336,343 of which had full dual coverage and 72,465 partial dual coverage. Most or moderately effective contraceptive use was seen in only 8.7% of women with full dual coverage and 4.2% of women with partial dual coverage, and LARC was seen in 1.4% and 0.7% respectively.

Contraceptive use was improved in patients with Medicaid coverage only, with most or moderately effective contraceptive use seen in 20.1% and LARC use seen in 3.2%. 

These results showed significant lower rates of effective contraceptive use among female patients with dual coverage. Investigators recommended further research on the reproductive healthcare needs of women enrolled in Medicare and Medicaid.

Reference

Rodriguez MI, Meath THA, Daly A, Watson K, Kim H, McConnell KJ. Disparities in effective contraceptive use in the United States among individuals dually eligible for Medicare and Medicaid. AJOG Glob Rep. 2023;3(3):100221. doi:10.1016/j.xagr.2023.100221