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The 2010 health law removes one of the big barriers to contraception for many young women: cost. But if they don't feel confident that the care they will receive is confidential, these women may not take advantage of it.
Under the health care overhaul, most new health plans and those that lose their grandfathered status have to cover many women's preventive benefits, including contraception without out-of-pocket costs. Copayments for monthly packs of brand-name birth control pills can run as much as $40 or $50.
A thicket of federal and state laws protect patients' confidentiality. Yet insurers billing practices — especially the sending of so-called explanation of benefits notices to the parents of children covered by family plans — routinely violate teenagers' and young adults' privacy. The companies send EOB notices to the primary policy holder, generally a parent, according to a recent analysis published by the Guttmacher Institute, a reproductive services research and education organization.
This problem may grow as more young adults stay on their parents' health plans after they finish school and move out on their own. Under the health law, adult children can remain on parents' plans until they reach age 26. So far, more than 3 million young adults have gotten coverage because of the law, according to the Department of Health and Human Services.
As a practical matter, though, young women may be reluctant to take advantage of the new benefits if they worry that their parents will receive an insurance form alerting them that they went to a gynecologist and got a prescription for birth control or got tested for HIV. In fact, only 68 percent of teenagers and 76 percent of young adults with private insurance used it to get contraceptive services, "likely at least in part because of confidentiality concerns," according to a Guttmacher Institute analysis of data from the National Survey of Family Growth.
In contrast, 90 percent of women over 30 used their insurance coverage to pay for such services.
Young women concerned about their parents' reaction may shell out for their preferred pills, perhaps switching to cheaper generics to save money.
They may also go to publicly funded family planning clinics. But those clinics are already stretched thin trying to meet the needs of uninsured and low-income young women. "It's a burden on family planning clinics," says Abigail English, director of the Center of Adolescent Health and Law and lead author of the recent analysis.