Making it easier to get preventive care is a central tenet of the Affordable Care Act. And access to birth control is critical to the health and well-being of women and their families.

That’s why it’s so disappointing that recent research shows insurance companies in Maine and 14 other states are flouting a federal mandate that they provide free contraceptive coverage. Women aren’t getting the services they’re entitled to – and they won’t until consumers and consumer advocates are taken seriously and insurers are pressed for greater compliance and transparency.

The benefits of birth control are many: It offers women greater opportunities to get an education, participate in the workforce and raise happy, healthy, financially stable families.

But for many women, expense is a major barrier to using contraception. The most popular form of birth control – the pill – costs uninsured women $100 a month. The method with the lowest failure rate – the intrauterine device – has a lifespan of up to 10 years, but its out-of-pocket up-front cost is a steep $1,000.

Insurers are supposed to provide no-cost coverage of all 20 forms of birth control approved by the Food and Drug Administration. In a survey of over 100 insurers in 15 states, however, the National Women’s Law Center learned that this mandate hasn’t been carried out.

In Maine, for example, Anthem Blue Cross and Blue Shield (the state’s largest insurer) doesn’t cover emergency contraception, even though the ACA requires insurers to cover over-the-counter methods at no cost if they’ve been prescribed by a doctor. Without a prescription, the cost of the so-called “morning-after pill” ranges from an average of $41 for the generic version to $48 for the brand-name product – a significant expense for many women.

In other states, insurers are covering only generic contraception, or they’re charging co-pays for methods other than the pill, like the IUD or the patch.

Women have been advised that in order to avoid out-of-pocket costs, they should use a type of contraception other than the one they’ve been prescribed. But not every method works for every woman – research suggests, for instance, that smokers over 35 should avoid taking the pill.

Women are left with several choices, each unpalatable: Pay out of pocket for the method that’s most suitable for them; use the method that their insurer covers, despite its drawbacks; or forgo contraception altogether.

Reports that women have had a hard time accessing contraception have drawn a lot of high-level attention; through a spokeswoman, the head of the federal Department of Health and Human Services has vowed to clarify guidelines for state insurance regulators.

But that alone won’t solve the problem: States should closely review the details of insurance plans and make sure that insurers correct violations. Insurers should make it clear to the public what services they do and do not cover.

Women should educate themselves about their rights and work with advocacy groups like Consumers for Affordable Health Care to hold insurance companies accountable. The greater the involvement of all stakeholders, the better the chance that women will receive the care they need and deserve.

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