Out-of-pocket costs for long-acting reversible contraception among individuals enrolled in employer sponsored insurance plans.

Abstract

Objective: Recent research finds that a significant share of long-acting reversible contraceptive (LARC) users with private insurance incur out-of-pocket costs associated with contraceptive services and supplies, despite the Affordable Care Act's (ACA) requirement that contraceptives be covered without cost-sharing. This analysis aimed to advance our understanding of what contributes to the out-pocket costs for intrauterine device (IUD) and contraceptive implant insertions by looking at all services and costs associated with insertion among privately insured individuals.

Study design: Using the 2023 Merative MarketScan Commercial Claims and Encounter Database, a national sample of healthcare claims for people enrolled in employer sponsored insurance plans, we estimated out-of-pocket costs for 98,916 IUD and 30,259 implant insertion encounters among females ages 15-49.

Results: Only 2.4% of IUD and 4.0% of implant insertion encounters had out-of-pocket costs related to the LARC device or insertion procedure itself. However, we find that nearly half of IUD (45.7%) and over a third of implant (35.8%) insertion encounters resulted in out-of-pocket expenses for other services commonly provided as part of a LARC insertion, such as pregnancy tests, office visits, ultrasounds, STI tests, and pain medication. Among insertion encounters with cost-sharing, the median out-of-pocket cost was $35.00 (25^{th -} 75th percentile: $15.00 - $90.00) for an IUD insertion and $16.88 (25^{th -} 75th percentile: $7.75 - $40.00) for an implant insertion.

Conclusion: Despite a federal requirement that insurance cover the full cost of contraceptive services and supplies, a sizable share of IUD and contraceptive implant insertions result in out-of-pocket charges for privately insured patients.

Implications: While privately insured women rarely pay out-of-pocket for a LARC device or insertion procedure itself, other services commonly provided as part of the LARC insertion often result in out-of-pocket costs, highlighting areas for clearer guidance, stronger oversight, and better patient and provider education on coverage of services related to LARC provision.