commonly used reversible methods, are routinely covered by only one-third of large-group plans, this did not result from a failure to cover prescription drugs. Although virtually all of the plans typically cover prescription drugs, two-thirds of these do not routinely cover oral contraceptives. Similarly, although more than 90 percent of the plans typically cover medical devices in general, less than 20 percent of these plans cover IUDs or diaphragms and 25 percent cover hormonal implants. In addition, the study found that less than a fourth of the plans routinely cover contraceptive counseling (The Alan Guttmacher Institute, 1994). Thus, many privately insured women who need contraceptive care must go out of plan and pay for it themselves, use over-the-counter methods that may be less effective, or not use any method at all.

Health Maintenance Organizations

Demonstrating their emphasis on preventive care, many health maintenance organizations (HMOs)—although not all—provide more comprehensive coverage for contraception than do typical fee-for-service plans. Only 7 percent of HMOs provide no coverage at all, and 40 percent cover all five methods noted above. Still, coverage of the various methods is far from uniform or complete, from 59 percent for Norplant insertion, to 84 percent for oral contraceptives, to 86 percent for IUD insertion. However, coverage of contraceptive counseling is routinely covered by at least 90 percent of HMOs. Even though HMOs cover a wider range of contraceptive services than do private plans, they nonetheless frequently require copayments for those services, which may serve as a deterrent for some women (The Alan Guttmacher Institute, 1994). In addition, adolescents especially may be reluctant to obtain contraceptive care as a dependent in a managed care setting, fearing that confidentiality will not always be maintained.

It is important to stress that these data on HMOs do not necessarily reflect the practices of all managed care arrangements, including both Medicaid managed care systems and for-profit networks. There are an increasing number and variety of such arrangements, but no data are available to assess how they address contraceptive services and supplies. Particularly in systems that are highly cost-competitive, coverage of both preventive services and prescription drugs (within which many of the more effective reversible methods of contraception fall) may be limited.

Public Sector Programs

In contrast to private insurance coverage and HMOs, the Medicaid programs of all 50 states and the District of Columbia provide reimbursement for contraceptive services, as required by law. Moreover, since the late 1980s,



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