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Our lawyers are waging strategic fights that make clear what is at stake for people who can become pregnant and seek to bolster our fundamental rights to control our lives, futures, and destinies.
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This new year, you might never have to pay for condoms again!
That celebratory (+ sultry) news is thanks to the updated Women’s Preventive Services guidelines which now specify that external condoms (sometimes called “male condoms”) will be covered by the Affordable Care Act without out-of-pocket costs, just like other forms of birth control.
In 2018, around 21% of women used external condoms as their primary source of pregnancy prevention, so coverage of external condoms should make a real difference for people right away.
This is an exciting change – but like anything related to health insurance, it comes with confusing parameters that can be – at times – nearly impossible to navigate.
That’s why we’ve created this Q & A—to give you a quick run-down, and to ensure that, no matter what, you can access whatever type of birth control you need!
How do I get my condoms covered?
First, check to make sure you have the type of health insurance plan that must comply with the ACA’s birth control benefit – then, double check that your plan year began on or after December 30, 2022.
If you do, that plan should now cover at least one type of external condom without out-of-pocket costs. In some states, health plans are required to cover over-the-counter contraception (like external condoms or emergency contraception) regardless of whether you have a prescription or not. But for the most part, health plans will require you to get a prescription. More on that next.
How do I get a prescription for condoms?
Just like any other prescription, really! If you have a health care provider, you should be able to get a prescription for external condoms from them. In some states, you can be prescribed contraceptives through a pharmacist.*
*HOT TIP: Even if pharmacists in your state can prescribe birth control… they might be limited to certain kinds. (Very sneaky).
Before making the trek to the pharmacy, we would suggest calling ahead or reviewing the rules for your state, just to be extra safe.
Does this mean my cis-male friend can get external condoms covered on his plan as well?
Unfortunately, the ACA birth control benefit only extends to anyone who can or may become pregnant, including adolescent and adult women, nonbinary people, and transmen. As a result, cis-men will not have access to the $0 cost provision.
What about the internal (female) condom, is that covered too?
YES! Because the ACA requires most plans to cover all FDA-approved methods of contraception, the internal condom is covered with $0 out-of-pocket costs when prescribed by a doctor. Currently, FC2 is the only FDA-approved internal condom on the market. For more information on how to get FC2, check out their website here. If you or someone you know is struggling to get coverage of FC2, you can contact CoverHer here.
Here at the National Women’s Law Center, we are encouraged by this update to the ACA’s birth control benefit, especially given that the previous guidelines did not encompass contraceptives that were not “female-controlled.”
A.k.a. under what they previously considered “female controlled,” you could get the pill for free…but had to pay for a box of external condoms.
That’s a load of B.S.
Because we all prefer – and our bodies all need – different forms of birth control. We shouldn’t be forced to use a specific method just because it’s the only one our insurance covers.
These new guidelines are a small but substantial victory in the fight for greater bodily autonomy – and for increased access to contraception nationwide. It’s important that we continue to share our stories and experiences navigating care within a complex healthcare system.
While the work continues, it feels good to take a moment to celebrate the wins!
