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ObamaCare: Leaving Men Hanging On Vasectomy Coverage

March 25, 2015

ACA-men-vasectomyObamaCare was generous to women but not so nice to men with vasectomy coverage.

Under ObamaCare, also known as the Affordable Care Act, it is easier and more affordable for women to obtain birth control and tubal ligations but harder for men to obtain vasectomy.

The cost of vasectomy ranges from $500 to $5000 but what you pay for your vasectomy depends on the quality of your health insurance coverage.

Although vasectomy is a simple quick, effective, procedure performed in a doctor’s office, arranging a vasectomy procedure can seem like major surgery when negotiating with your health insurance plan.

Unfortunately since the passage of the Affordable Care Act the answers to who has coverage for vasectomy and how much the vasectomy costs remain as complicated as ever.

Affordable Care Act and vasectomy

The Affordable Care Act was very generous to women by providing no cost coverage for contraception and sterilization to women.

The specific language in the Federal Register states,

“The HRSA Guidelines include all Food and Drug Administration (FDA)-approved contraceptive methods, sterilization procedures, and patient education and counseling for women with reproductive capacity, as prescribed by a health care provider (collectively, contraceptive services).1”

What this language means is all women who have health insurance can obtain birth control and tubal ligation at no cost. This means deductibles and copayments are not applicable for women. This is a great mandate for protecting women’s reproductive health and insuring equal access to birth control for all women who have health insurance.

Unfortunately, the Affordable Care Act was not so generous to men in regards to birth control and vasectomy. The same language quoted above is footnoted with the following,

1 The HRSA Guidelines exclude services relating to a man’s reproductive capacity, such as vasectomies and condoms.

Headlines! Vasectomy coverage complicated by a single footnote

What this simple footnote does is mandate men who have health insurance are at the mercy of their individual health plans on vasectomy coverage. Market forces are at play and insurance companies can decide to offer or not offer vasectomy coverage and they can use the financial leverage of co-payments and deductibles to their advantage.

The Affordable Care Act makes it more affordable for women to get tubal ligations but does not do the same for men. Although the intent may have been good for women’s health, the lack of a vasectomy coverage mandate contributes to the already significant burden women face when couples are considering tubal ligation or vasectomy.

Coverage of Certain Preventive Services Under the Affordable Care Act page 39870

A leading group of reproductive health care providers, The Association of Reproductive Health Professionals, has issued a statement encouraging ACA coverage of vasectomy: Putting the man in contraceptive mandate. More professional physician groups are needed to have vasectomy covered at no cost like tubal ligations are covered.

How much does a vasectomy cost?

Since the Affordable Care Act does not mandate vasectomy be covered at no cost then health insurance companies are responsible for making the ultimate decision on vasectomy coverage.

Most health insurance plans do provide some coverage for vasectomy but it is estimated that 10% of plans do not cover vasectomy procedures. The amount of coverage each plan provides depends on the quality of the individual plan.

Unfortunately the Affordable Care Act continues to place the burden of seeking birth control onto women by allowing them unrestricted, no cost access to birth control. The Affordable Care Act even further shifts the burden onto women by not mandating coverage for vasectomy and allowing men to remain at the mercy of the financial decision making of health insurance companies.

Affordable vasectomy: Reducing barriers to the most effective birth control for men

At His Choicewe realize the complexity of the decision making one must undergo when considering a vasectomy. There are personal, societal, and financial obstacles one must navigate. Although we cannot help make your personal decisions, we can reduce societal and financial barriers by allowing our patients the choice of a single visit vasectomy procedure and keeping it affordable.

Although many men have insurance, we understand those with high deductibles are financially burdened when it comes to seeking preventative health care and this is one reason we have chosen to keep vasectomy affordable and allow men the choice of having their vasectomy done during a single office visit.

Dr. Monteith is the Medical Director of His Choice and a specialist in no needle, no scalpel vasectomy and vasectomy reversal surgery in Raleigh North Carolina.

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