The contraceptive coverage guarantee of the Affordable Care Act (ACA) requires that privately insured women receive insurance coverage for US Food and Drug Administration (FDA) - approved contraceptive methods sterilization procedures and patient education and counseling without any out-of-pocket costs. Medicaid recipients have been excluded from this requirement. This coverage must encompass the clinical visit services needed for provision of contraception follow-up and management of adverse effects counseling for continued adherence and device removal. The guarantee is not absolute and does not apply to supplies (such as emergency contraception) obtained without a prescription nor does it apply to methods used by men (eg vasectomy male condoms). Plans can exclude coverage or require cost sharing for out-of-network services and supplies. Some plans are exempt including so-called grandfathered plans (preexisting plans given a temporary reprieve from many ACA rules) and plans of some religious employers. Despite these limitations the ACA provision has already directly benefited millions of women who use contraceptives by decreasing their total out-of-pocket spending on contraceptives. Prior to the ACA high initial costs were barriers to women using highly effective contraceptive methods such as intrauterine devices (IUDs) and implants. Cost also affected adherence to commonly used refillable methods such as oral contraceptive pills the contraceptive patch or the vaginal ring with recurring prescription co-payments previously required. The provision has the potential to substantially improve public health. Access to contraception without financial barriers reduces unintended pregnancies and births which in turn can improve maternal and infant health. Contraceptive access also can help women achieve their educational and workplace goals and support themselves and their families. Insurance companies benefit from the contraceptive coverage provision because all methods are cost saving after accounting for the costs of unintended pregnancies and births. (excerpt)