Number of IUD Insertions Increases After ACA Contraceptive Mandate

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Increase in use depends on the amount of reduction in out-of-pocket costs
Increase in use depends on the amount of reduction in out-of-pocket costs

HealthDay News — Women in insurance plans with the greatest drop in out-of-pocket cost after the Affordable Care Act's contraceptive mandate had the greatest gains in intrauterine device (IUD) placement, according to a study published online April 9 in Obstetrics & Gynecology.

Erica Heisel, from University of Michigan in Ann Arbor, and colleagues evaluated changes in out-of-pocket costs and the number of IUD placements before and after mandated coverage of contraceptive services among women enrolled in employer-sponsored health plans (2009 to 2014).

The researchers found that average plan utilization of IUD services showed a significant increase between 2009 and 2014 (12.5 vs 13.8%; P < 0.001). There were significant differences in plan utilization over time when plans were grouped by out-of-pocket cost level. Specifically, plans that had a high out-of-pocket cost in 2009, but no out-of-pocket cost in 2014, saw a higher average increase in the rate of plan IUD insertions over time vs plans with no out-of-pocket cost at both time points (P = 0.02). For all plans, in 2009 the 75th percentile of out-of-pocket cost was $368, compared to $0 in 2014.

"Women in plans with the greatest reduction in out-of-pocket cost after mandated coverage of contraception had the greatest gains in IUD insertion," the authors write. "This suggests that baseline cost should be considered in evaluations of this policy and others that eliminate patient out-of-pocket cost."

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