Summary: Each year, around 500,000 men in the U.S. get vasectomies. But as for how insurers will cover vasectomies under the Affordable Care Act, it seems the answer is no. Read on for our advice, or…
Kaiser Health News reports that while insured women will qualify for contraceptives without a copayment under the Affordable Care Act, it’s not clear how this will ultimately extend to male contraception coverage.
So far, insurers are interpreting the law to include only female-based contraception, and they’re saying that the requirement to waive co-payments does not apply to methods and procedures for men.
The Case for Covering Vasectomies
The Affordable Care Act requires that most private health plans cover four groups of preventive health services without any co-payments, deductibles, or other out-of-pocket costs. Contraceptive methods and counseling are included for women’s preventive care. And because that set of recommendations is limited to women, vasectomy is not legally required under that provision.
But Adam Sonfield, a senior public policy associate at the Guttmacher Institute, a reproductive health research group, told Kaiser that it would be foolish to exclude vasectomies. He noted that they are less costly and risky than female surgical sterilization.
“It doesn’t mean that health plans won’t cover vasectomy,” Sonfield told ClearHealthCosts. “Health plans could even decide to cover it free of out-of-pocket costs, so as not to encourage couples to choose female sterilization over vasectomy. Vasectomy is less expensive and less invasive, and just as effective. But they’re not required to do so under the ACA.”
The Legal Nitty-Gritty
There’s a lot of confusion about this. Dawn Stacey, the author of About.com’s contraception guide, reported that new private health plans written on or after Aug. 1, 2012, plans must now cover — without out-of-pocket costs — all FDA-approved birth control options, including vasectomies. But that doesn’t appear to be the case, according to the U.S. Department of Health and Human Services.
A bulletin from Health and Human Services about the August effective date says the date applies to “all FDA-approved contraceptive methods, sterilization procedures, and patient education and counseling for all women with reproductive capacity.” But what about men and vasectomies? Certainly that’s an FDA-approved sterilization procedure, but there’s no mention of men anywhere.
If men were excluded, it’s because men’s preventive health didn’t receive the same focused attention as women’s health issues while the legislation was debated. Sen. Barbara Mikulski (D-Md.) championed adding women’s preventive services following recommendations by the Health Resources and Services Administration, and those recommendations did not include any mention of vasectomies.
So where does that leave men? Assuming that Obamacare is not amended to cover vasectomies, men could find themselves paying anywhere from $300 to more than $3,000 for the procedure, which takes 30 minutes or less and is done on an outpatient basis.
Here’s a price list for New York City area providers, and a price list for San Francisco providers. In Texas, the prices ranged from around $400 to more than $5,000; here’s a list of prices for the removal of sperm ducts (CPT code 55250) in Texas; here’s a list of prices for the no-needle no-scalpel vasectomy (CPT code 55450) in Texas.
If you missed our first post about the cost of vasectomies and the different considerations around them, you can find it here: How much does a vasectomy cost?