US insurance coverage of contraceptives and the impact of contraceptive coverage mandates, 2002

CONTEXT: In 1993, coverage of reversible contraception by U.S. health insurance plans was extremely low. Little is known about how coverage has changed since then, particularly in response to state mandates. METHODS: In 2001-2002, a notionally representative sample of 205 health care insurers responded to a survey about coverage of reproductive health care services in "typical" employment-based managed care plans (excluding self-insured plans). Data were analyzed to compare coverage in states with and without contraceptive coverage mandates, and to show trends in coverage between 1993 and 2002. RESULTS: In 2002, almost every reversible contraceptive service and supply studied was covered by at least 89% of typical plans, 86% of plans covered the five leading prescription methods (the diaphragm, one- and three-month injectables, the IUD and oral contraceptives). Coverage of each contraceptive service and supply studied was higher in 2002 than in 1993 (78-97% vs. 32-59%). Plans in states with mandates were significantly more likely to cover the five leading prescription methods (87-92%, depending on type of plan) than were those designed locally in states without mandates (47-61%). Between 1993 and 2002, state mandates were estimated to account for 30% and 40% of the increase in coverage of oral contraceptives and the three-month, injectable, respectively. CONCLUSIONS: Coverage of reversible contraception-and by Extension, choice within a range of covered methods-has increased substantially since 1993, in part because of state mandates. This state-by-state approach, however, has inherent limitations that can best be dealt with at the federal level.