TIME Health Care

Studies Show Obamacare is Reducing the Ranks of Uninsured

Ronnie Cabrera, Dailem Delombard and Maylin Lezcano holding Lucas Cabrera sit with an insurance agent from Sunshine Life and Health Advisors as they try to purchase health insurance under the Affordable Care Act at the kiosk setup at the Mall of Americas on January 15, 2014 in Miami.
People buying health insurance under the Affordable Care Act at the Mall of Americas on Jan. 15, 2014 in Miami. Joe Raedle—Getty Images

Data for Democrats to tout ahead of midterm elections

A growing body of research indicates that the number of American adults who lack health insurance has dropped sharply, by about eight million, since the health care reform law’s individual mandate went into effect early this year.

Three independent studies from the Commonwealth Fund, Gallup, and the Urban Institute recently found that roughly a quarter of people who were uninsured last year now have health insurance.

The proportion of people without insurance dropped across all income groups and ethnicities. But the largest declines were seen among the poor and Latinos, for whom the uninsured rate plummeted from 36% in the summer of 2013 to 23% by the spring of 2014, according to the Commonwealth Fund.

In its survey of 45,000 U.S. adults, Gallup found that the uninsured rate for Americans over 18 has fallen to 13.4%, the lowest level since the group began tracking the metric in 2008. The previous low point was 14.4% in the third quarter of that year.

The drop in the ranks of the uninsured marks a significant step toward the President Barack Obama’s goal of universal health insurance coverage in the U.S. and will be welcome news to Democrats heading into the 2014 midterm elections. Campaigning against Obamacare has been central to the GOP’s election-year strategy and Republicans have hammered Democrats over the Affordable Care Act’s initially rocky rollout.

But the news is unlikely to soften Republican opposition to the law. The GOP-controlled House is already moving forward with a lawsuit against the President over his decision to delay implementation of the so-called employer mandate, a key provision of the law that requires companies with more than 50 full-time employees to provide health insurance. Some in the GOP have accused the President of unilaterally delaying implementation of the measure to avoid hurting Democrats going into the midterm elections.

TIME White House

Obama’s New Drug Policy Looks a Lot Like the Old One

Michael Botticelli
Michael Botticelli, left, acting director of National Drug Control Policy, speaks to community leaders in Roanoke, Va., on July 9, 2014 Erica Yoon—AP

A new emphasis on treatment and addiction, but no change on marijuana

The Obama Administration unveiled an updated drug policy Thursday, including a new emphasis on treatment and addiction programs and a push to curb abuse of heroin and prescription painkillers.

Michael Botticelli, the acting director of the Office of National Drug Control Policy, framed the retooled strategy as a shift away from the punitive policies that have produced record incarceration rates.

“Our prisons and jails are already overcrowded with people who desperately need compassionate, evidence-based treatment for the disease of addiction—not a jail cell,” Botticelli said in a statement before an event in Roanoke, Va.

Among the elements of the plan are expanded access to drug education, treating drug addition as a health issue rather than a criminal one, and a push to divert nonviolent drug offenders into treatment rather than prisons. It promotes tackling the twin scourges of heroin and prescription opiates, whose abuse rates have climbed.

The Administration’s call for criminal-justice reform reflects widespread agreement, inside the White House and out, that the war on drugs has been a misbegotten failure. The Department of Justice has emphasized the need to overhaul its approach from being “tough on crime” to being “smart on crime.” The updated policy is a continuation of that strategy. “The plan we released today calls for reforming our criminal justice system to find alternatives to incarceration—and effective interventions across the entire system to get people the treatment they need.”

But for the most part, the Administration’s approach looks like more of the same. It outlines no changes to the White House’s approach to marijuana, a blow to legalization advocates in the same week that Washington state became the second to legalize the sale of cannibis to adults for recreational purposes.

Despite the President’s belief that pot is less harmful than alcohol, federal law still classifies it as a Schedule I drug on par with cocaine and ecstasy. Discrepancies between state and federal pot laws have blocked legitimate weed-business owners from accessing banks and left the threat of jail time looming over users, sellers and growers even in states where some form of the drug is now legal.

The new strategy calls the increasing perception that cannabis is relatively harmless—fed not only by state legalization efforts, but also perhaps the President’s own remarks to that effect—a “serious challenge” to drug reform efforts.

“The drug czar’s office is still tone deaf when it comes to marijuana policy,” said Mason Tvert, spokesman for the Marijuana Policy Project. “Why stay the course when the current policy has utterly failed to accomplish its goals?”

MONEY Budgeting

3 Ways to Inflation-Proof Your Life

Jason Hindley

The official inflation rate is low, but your personal CPI may be high. Keep it grounded with these moves.

Since the Great Recession, inflation has been unusually low, inching along at well below the 3% historical average. And over the past 12 months, the consumer price index has clocked in at a ho-hum 2.1%. But you are not the U.S. economy, and the costs of being you haven’t stagnated.

In some cases, that’s a good thing. If you’re in the market for a new TV or computer, for instance, you’ll pay dramatically less than you would have five years ago (see chart, below). Yet during the same period, prices of many of the biggest and most common expenses families pay, from child care and health care to key grocery items, have shot up. Meanwhile, in real terms, salaries are stuck in molas­ses, so consumers have roughly the same income as they did before Lehman Brothers collapsed.

Use these moves to keep price increases from eroding your paycheck.

Costs of Raising Junior

Strategy: Let Uncle Sam help. Diapers, summer camp, and orthodontia may be budget killers. But the biggest strain on parents comes from two expenses: child care (up from an average $87 a week in 1985, adjusted for inflation, to $148 now) and college (tuition and fees for state schools: up 27% in real terms since 2008).

Tax breaks can help you reduce those costs. Got children under 13? Sign up at work for a dependent-care flexible spending account to use pretax dollars to pay for up to $5,000 of child-care bills, says J.J. Burns, a Melville, N.Y., financial planner. That saves you up to $1,400 in the 28% bracket.

Your company doesn’t offer the FSA, or your costs exceed the limit? Claim the child-care tax credit on your 1040 for up to $3,000 in bills for one kid, $6,000 for two. A married couple filing jointly with adjusted gross income (AGI) over $43,000 can write off 20% of bills up to these amounts.

As for college, saving via your state’s 529 plan may put money back in your pocket, says Savingforcollege.com founder Joseph Hurley; check “What’s the Best 529 Plan for Me?” to see if that’s true for you. Contributions grow tax-free and are fully or partly deductible in 34 states and D.C. (withdrawals are tax-free in every state). Plus, once your child is in school, you may qualify for the American Opportunity Tax Credit on tuition and fees worth as much as $2,500 and a deduction of up to $2,500 on student-loan interest.

Everyday Expenses

Strategy: Find a cheaper substitute. If you grilled hamburgers this Fourth of July, then you already know about skyrocketing meat prices. And that’s not all: The prices of car insurance, butter, milk, and eggs have all risen at double or triple the CPI. For gas, make that sevenfold.

Solution? Substitute a lower-cost item or supplier that can fill the same need. Trade T-bones for chicken breasts—the price of which has tracked inflation the past five years. Reach for a glass of wine (down 2% over the past five years) instead of a bottle of beer (up 9%).Then take the strategy wider. Carpool to work or use public transit to save on gas. And shop around for a cheaper auto insurer.

Health Care Costs

Strategy: Comparison-shop. Workers’ contributions to health care premiums have climbed 26% in real terms since 2008, based on data from the Kaiser Family Foundation. Prescription: Compare prices, which vary widely even in-network for doctors, services, and drugs. By logging on to your insurer’s web tool you can save thousands on MRI and CT scans, specialists, and physical therapy.

Also, to avoid big bills later, take advantage of free preventive care like physicals, which most plans must now offer, says Katy Votava, president of Goodcare.com, a health-plan consultancy. You can’t do much better than paying zero.

What's cheaper

MONEY Health Care

Why Your Boss Isn’t Dropping Your Health Plan (Yet)

Robert A. Di Ieso, Jr.

Obamacare requires most employers to offer coverage next year, but fears persist that many will dump workers onto the insurance exchanges instead. Fear not, for now.

Q: I’ve heard that some firms may drop their health plans and have workers purchase a plan on the government exchanges. Will that happen to me?

A: Nine months after the launch of the controversial health insurance exchanges, confusion hasn’t died down over what exactly health reform means for the average American. A new poll found that 65% of workers are very or somewhat worried that their firms will drop health coverage and have employees go it alone on the new federal and state insurance exchanges.

Such a move would hurt, at least in workers’ minds, according to the survey of 1,240 likely voters by Morning Consult, a digital media company. Half said that if their employer exited the benefits business, they would be negatively affected; only 16% expected to benefit from such a switch.

Even though Obamacare requires firms with 50 or more workers to offer insurance or owe a fine starting in 2015, the concern is that some will opt to pay the fine, since individual coverage can cost two to three times as much—and substantially more for a family plan. What’s more, employers with fewer than 50 workers that already offer health benefits—even though they are not required to—may decide to get out of the business now that all workers have the alternative of buying coverage on an exchange.

Are workers right to worry about getting dumped? As long as you work for a large firm, you shouldn’t lose sleep over the issue, at least not yet, says Beth Umland, director of research for health and benefits at consultant Mercer. Earlier this year—well after the exchanges went live—an overwhelming 94% of big firms reported that they will keep offering health coverage for the next five years, Umland says. That percentage has remained consistent since Mercer first asked the question in 2008.

Separate research from the National Business Group on Health, which represents large employers, also found about 95% of those firms plan to stick with the status quo, says CEO Brian Marcotte.

A wait-and-see approach

Big business remains committed for lots of reasons, experts say. For one, good benefits are crucial to attracting talent. More than 90% of workers say health-care benefits are as important as pay, according to Mercer. In the Morning Consult poll, more than half of respondents say they would consider looking for a new job if they had to shop for coverage.

Company leaders are also uncertain about how premiums and plan features on the individual market will evolve after last year’s shaky launch. Until the exchange offerings become more predictable, executives are unlikely to send their employees there, with or without a subsidy to buy coverage, says Tracy Watts, who leads the health care reform group at Mercer.

Even then, large firms may not go that route. “The math doesn’t work for most firms,” says Watts. Today your boss pays its share of your health premium with pre-tax dollars. If the firm decides to offer you a subsidy to buy your own plan instead, the loss of that tax benefit means it would likely have to dole out more for you to get the same plan—or risk facing worker backlash.

Smaller firm, bigger risks

You’re more likely to be moved to an exchange if you’re at a firm with fewer than 50 workers. About one-third of small businesses that offer coverage today say they are considering getting out of the game, up from only 23% a year ago, says Mercer’s Umland.

You also face a higher likelihood if you work at a firm with a large low-wage or part-time workforce, such as a store or hotel, says Marcotte. Many firms in those industries do not offer health insurance to all their workers today. Rather than add them to the plan, companies may decide workers are better off on the exchanges, where they can qualify for government subsidies only if their boss fails to offer an affordable plan.

Keep in mind that while most firms say they’ll remain in the game for the foreseeable future, they’re not nearly as confident over the long haul. “Health care is changing pretty rapidly right now,” says Marcotte. “So they’ve got to look at it every year.” By then, though, you too should have a better sense of how you’d fare on your own too.

MONEY health

WATCH: The Cost of Trying for a Baby

Meet Carrie and Dan Zampich, who have spent $55,000 on fertility treatments over the past five years.


Why Most Seniors Can’t Afford to Pay More for Medicare

Replacing Medicare with vouchers would push costs higher and put older Americans at risk.

Should seniors pay more for Medicare? Republicans think so; they have repeatedly called for replacing the current program with vouchers that would shift cost and risk to seniors.

There’s no doubt this is where Republicans will take us if they capture control of Congress this year, and the White House in 2016. Representative Paul Ryan, the Wisconsin Republican who chairs the House Budget Committee, advocates “premium support” reforms that would give seniors vouchers to buy private Medicare insurance policies in lieu of traditional fee-for-service Medicare.

Under the latest version of Ryan’s budget proposed in April, starting in 2024 seniors could opt to buy premium-supported private plans or stay in traditional Medicare. Ryan has argued that introducing competition will bring down costs over time, and capping the government’s costs does sound like a tempting way to address Medicare’s financial problems.

Medicare’s trustees project total annual spending will jump 78% by 2022, to $1.09 trillion. Much of that increase will be fueled by higher enrollment as the baby boom generation ages.

But premium supports would shift risk to seniors, and could effectively make traditional Medicare much more expensive by siphoning off healthier seniors to private plans. The Congressional Budget Office has estimated that this effect could boost traditional Medicare premiums 50% by 2020 compared with current projections.

Most seniors simply can’t afford to pay more. If you doubt it, check out the new interactive tool launched last month by the Henry J. Kaiser Family Foundation, one of the country’s leading healthcare research groups.

The tool analyzes the income and assets of today’s 52.4 million Medicare beneficiaries, and how their financial picture will change between now and 2030, when 80.9 million people will be covered by the program. It can compare different demographic slices of the Medicare population based on variables such as education, race, gender and marital status—and here you get a stark look at how economic inequality affects the pocketbooks of seniors.

Kaiser’s tool is based on a simulation model developed by the Urban Institute that uses population data to analyze the long-range impact on retirement and aging issues. I encourage you to test-drive the tool, but here are some highlights:


Fifty-three percent of Medicare beneficiaries had $25,000 or less in annual income last year; half had savings below $61,400 and less than $67,700 in home equity on a per-person basis.

The income figures reflect the sharp divisions that characterize the wider U.S. population. Just 4% of seniors had income over $100,000 last year; 27% had income below $15,000 (which is just a bit higher than the average annual Social Security benefit).

Healthcare already is one of the largest expenses for seniors, most of whom are on fixed incomes. HealthView Services, which develops software for gauging healthcare costs, recently estimated that a senior retiring this year in high-cost Massachusetts would pay $7,020 in Medicare premiums alone—a number that will jump to $11,536 in 2024. And that figure doesn’t include co-pays and out-of-pocket costs for things Medicare doesn’t cover, such as dental care. It also doesn’t include costs for a catastrophic event.

“Sixty-six thousand in savings is less than the cost of one year in a nursing home,” says Tricia Neuman, senior vice-president at the foundation and director of the foundation’s Medicare policy program. “That tells us that many people on Medicare today don’t have the resources they’d need to pay for a significant health or long-term-care expense if it should arise.”


Neuman says she was especially surprised by the extent of the gaps in income and saving by race, ethnicity and gender. Median 2013 per capita income for white Medicare beneficiaries was $26,400, compared with $16,350 for African Americans and $13,000 for Hispanics.

Men had $25,880 in median income, compared with $21,800 for women. And married couples were better off than singles: Per capita income for married seniors in 2013 was $27,400, compared with $20,250 for divorced people, $21,050 for widows and $14,150 for those who never married.

That’s unlikely to change by 2030. “The model suggests there won’t be phenomenal changes in wealth, or that seniors will be that much more comfortable,” Neuman says.

Neuman says the data also points to continued income inequality and sharp divisions in the status of seniors. In 2030, 5% of Medicare beneficiaries will have income over $111,900, while half will have income below $28,250.

“There will always be a small share of the Medicare population with sufficient wealth and resources to absorb higher costs, but most will not be in that position,” she says. “The assumption that boomers are healthier and wealthier and that we’ll have a much rosier Medicare outlook down the road just isn’t going to happen.”

MONEY Health Care

Don’t Miss Out on This Powerful Way to Cut Your Health Care Costs

Medical bills are lengthy and complicated—and often wrong. Burazin—Getty Images

Doctor and hospital bills are riddled with errors. Learning to spot them could save you thousands on your care.

Health care is a $2.8 trillion industry in the U.S., and the billing system is filled with errors. How many? While it’s impossible to know for sure, there are some fairly good indicators.

Medicare overpayments in 2013 totaled $36 billion, according to the Department of Health and Human Services. A report by the Office of the Inspector General found that 42% of evaluation and management bills sent to Medicare in 2010 contained errors, costing taxpayers $6.7 billion. Those services don’t even include emergencies and hospital surgeries and inpatient stays, where there’s a lot more room for error.

Mistakes on hospital bills are widespread, says Pat Palmer, founder of Medical Recovery Services, a Salem, Va. organization that helps patients check and negotiate medical charges. “It’s astounding that eight out of ten hospital bills we receive contain numerous over-charges,” Palmer says.

Scrutinizing a medical bill may seem daunting, but with a few pro techniques on your side, you can catch some of the most common mistakes.

Don’t be too quick to pay

Many hospitals and clinics send statements with only one final amount, so start by requesting an itemized bill.

“My most critical advice to consumers is to never pay a hospital bill before receiving and reviewing a detailed, itemized medical bill,” Palmer says. “Otherwise, you are paying money to these facilities blindly.”

You should also have your health insurance explanation of benefits nearby before checking over the charges, since billing errors can result in coverage denials.

Learn to spot common errors

Once you have your itemized bill and EOB side by side, check to see that identifying information like your name, address, and Social Security number is correct on each statement. Misidentification is a common error, and if either your insurance company or the hospital has the wrong information, your entire claim can be rejected.

Next, make sure all medications listed on the hospital bill are correct and that you actually took them. During a hospital stay medications that have been prescribed are often discontinued or cancelled, yet they still appear on your bill. Similarly, if you know you did not receive a service such as an x-ray or blood test but see it on your bill, you’ve been overcharged, says Palmer.

After you’ve had surgery, look at the charges for the operating room, which are generally by the minute. If you know how long your surgery took, see if the time matches up. If not, check the minutes in the operating room against anesthesia start and end times—they should be similar.

Mistaken room charges also crop up frequently for overnight stays. If you were in a room with more than one bed, double check that you weren’t billed for a private room. This should be listed in the service charge, and will probably be one of the largest items on the bill, especially if you stayed multiple nights.

Finally, see if any item appears more than once, since duplicate billing is also common. These mistakes are the simplest to catch. Because of the fee-for-service coding system is complicated, others may be more difficult to spot.

How to fix what’s wrong

If you’ve found only one or two errors, you may be able to resolve them by simply reporting the mistakes to your hospital and health insurance provider. If mistakes are plentiful, set up an appointment to talk with the billing department of the hospital in person after you’ve alerted your insurance company.

If the bill is still higher than you think it should be, you can hire a medical billing advocate to help. Advocates are experts like Palmer who know how to work with hospitals and insurance providers to lower that bill.

Read more from NerdWallet Health, a website that empowers consumers to find high quality, affordable health care, and insurance.










TIME Religion

After Hobby Lobby: A Single-Payer Health Care Solution?

Perhaps both sides could agree it may be a way forward

Now that the initial shouting and—at times—vitriol from both sides has subsided after Monday’s Supreme Court ruling in the Hobby Lobby case, it’s time to take a sober look at what the ruling says about the future of health care reform in the United States. The majority’s ruling was an imperfect solution to a complicated case involving the reach of religious liberty to exempt organizations from providing certain medical benefits that they find morally objectionable to their employees. The fact that these medical benefits were almost exclusively offered to women makes this decision all the more difficult to accept for some.

But at its core, the case reveals something else as well. It brings to the forefront something we’ve all known for sometime: that Obamacare—for all the good it’s done in increasing access to quality and affordable healthcare—is a messy law. It asks employees to be at the whim of its employers’ objectives and mission for what health care benefits they receive. It also asks employers to at times reject its deepest convictions in order to provide certain benefits to its employees.

This isn’t sustainable. A person’s access to quality healthcare shouldn’t depend on who their boss is. And an employer shouldn’t be heavily fined if they don’t compromise their religious convictions in providing healthcare for their staff.

President Obama’s Affordable Care Act is a monumental first step in achieving a just and equitable American health care system that seeks first to serve those on the margins of society. But as we look towards the future, it’s necessary to consider major alterations or even alternatives to Obamacare to continue to advance healthcare reform.

For those of us who value both universal access to quality healthcare and the strong American tradition of protecting religious liberty, there might be a solution in a single-payer system.

A single-payer system overturns an unsound principle of Obamacare: relying too heavily on private organizations to deliver the public good of healthcare. When you require private organizations to enforce what the government believes ought to be public policy, you open yourself to a myriad of legal and ethical qualms. How can you expect organizations as diverse as Hobby Lobby, the Little Sisters of the Poor and the American Atheists to agree on what health care benefits are appropriate for their employees?

Amidst all the fuss this week over the Supreme Court ruling, both sides actually agreed on one thing: they disliked the accommodation provided by the Obama Administration for religious organizations. Religious groups argue the exemption is too narrow and doesn’t protect the autonomy of some organizations to practice their convictions. Women’s groups argue that the current accommodation unfairly denies women working for religious groups access to birth control, which is a basic benefit in any healthcare plan.

A single-payer public health care option eliminates such complications. No matter who your boss is or what business you work for, you get access to the healthcare you need. And employers will not be forced to compromise their religious beliefs while providing the public good of healthcare.

And let’s be clear, if you have something that is both supported by the United States Conference of Catholic Bishops and Planned Parenthood, you might be onto a plan that proves the angel Gabriel right: nothing is impossible with God.

Fred Rotondaro is the chair of Catholics in Alliance for the Common Good and a senior fellow at the Center for American Progress. Christopher Hale is a senior fellow at Catholics in Alliance for the Common Good. He helped lead national Catholic outreach for President Obama’s re-election campaign.
TIME medicine

Skip the Pelvic Exam, Says the American College of Physicians

But not everyone in the medical community agrees

A pelvic exam for women who are not pregnant and do not have symptoms of cancer may be unnecessary, says the American College of Physicians (ACP) in a controversial new set of guidelines published Monday in the Annals of Internal Medicine. The ACP, which reviewed studies on the harms and benefits of pelvic exams, says the procedure does not detect disease as well as previously thought; it doesn’t reduce mortality; and it leads to many false positives, resulting in unnecessary testing and anxiety.

For the uninitiated, here’s what happens when women visit the gynecologist: their legs go up in stirrups and the doctor looks at the genitals before inserting a speculum into the vagina to examine the cervix. (If a woman is getting a Pap smear, cervical cells are gently scraped off with a Q-tip-like tool.) Then, the doctor places one hand inside the vagina and the other on the abdomen and feels for anything that isn’t right on the ovaries and uterus. In some cases, the doctor inserts a finger into the rectum for the same purpose. This is the pelvic exam.

While the process is not painful, it’s certainly invasive. Now, ACP is questioning the necessity of this part of the checkup — commenting that “pelvic examination can cause anxiety, discomfort, pain, and embarrassment, especially in women who have a history of sexual abuse.”

But their guidelines are not being met with widespread praise. “I think in the obstetrics and gynecology world, everyone will laugh at this and think this is the silliest thing they have ever heard,” says Dr. David Fishman, a professor and director of gynecologic oncology research at Mount Sinai Hospital. “As a gynecological oncologist, my whole career has been spent on women who have no symptoms, and then an abnormal mass is found.”

Just on Monday, Fishman met with a young, healthy woman who had a mass on her ovary she had no idea was there. “We all know the pelvic exam is flawed. It’s not comfortable for the patient, some doctors do not like doing it.” says Fishman. “Maybe statistically [the pelvic exam] doesn’t make a difference, but to that family, you’ve saved a life.”

The American Congress of Obstetricians and Gynecologists (ACOG), considered the authority on reproductive health, still recommends yearly pelvic exams for women 21 years and older, though in a 2012 committee opinion, ACOG acknowledged that the “limitations of the internal pelvic examination should be recognized.”

The new recommendations open the doors to continued debate over physical exams, and when they are appropriate.


MONEY Health Care

What the Supreme Court Birth Control Ruling Means to You

Activists holding signs about Hobby Lobby case standing outside the Supreme Court
Activists outside the Supreme Court on March 25, 2014, when Sebelius v. Hobby Lobby Stores was argued. BRENDAN SMIALOWSKI—AFP/Getty Images

Thanks to Obamacare, most health plans have fully covered contraception since 2013. Will the Hobby Lobby court decision change what you pay? Here’s the lowdown.

This morning the nation’s highest court weighed in on a topic usually reserved for the doctor’s office or bedroom. In a 5-4 vote, the court ruled that the Affordable Care Act cannot require closely held, for-profit corporations to provide health insurance that covers contraception services for women when those services go against their religious beliefs. The anxiously awaited decision could have far-ranging implications for religious freedom and health reform.

Women and their partners, though, are likely wondering what the decision means for the cost of birth control. Here’s what you need to know.

What is the health insurance benefit at the center of this fight?

Starting last year, you no longer had to fork over any cash to buy contraception (aside from the premium you paid). Under Obamacare, most insurance plans, both individual and group policies, must fully cover preventive services designed to keep you healthy, such as mammograms, colonoscopies, and many vaccinations. After the Affordable Care Act was passed, the Institute of Medicine recommended that contraception be included on that list of no-cost services, says Judy Waxman, the vice president for health and reproductive rights at the National Women’s Law Center.

That has meant that most health plans must cover the full range of contraceptives approved by the Food and Drug Administration, including pills, rings, patches, shots, implants, intrauterine devices, barrier methods, and sterilization procedures. For each of these services, as long as you have a prescription from the doctor, you’ll pay nothing.

There are a few nuances. For example, if a drug comes in a generic version and you opt for the brand name, you may owe a co-pay or co-insurance (although there is a waiver process that grants you access to the premium drug at no cost if your doctor asserts you need it for a medical reason).

Previously, large group plans typically covered contraception but you had to cover a co-pay or co-insurance, according to David Dross, who runs the pharmacy practice at benefits consultant Mercer. You also owed your deductible before the coverage kicked in. So you may have paid the full cost for, say, ten months.

On Friday the Department of Health and Human Services announced that an additional 24.4 million prescriptions for oral contraceptives were given out with no co-pays in 2013 compared to 2012.

So what was the legal battle over?

In this case two for-profit companies, the big box craft chain store Hobby Lobby and cabinet maker Conestoga Wood, argued that they view certain types of contraception, such as morning after-pills Plan B and ella, akin to abortion and in violation of their Christian religious beliefs. They asked to be exempt from paying for those services.

Will the ruling change my insurance coverage?

If you work for a large, publicly traded company, the decision will likely not change what your birth control costs, says Waxman. The ruling specifies that only “closely held” firms, or those owned by a small number of individuals, with sincerely held religious beliefs can qualify for an exemption. So you’re unlikely to see a Fortune 500 company strip these services from their health plans any time soon.

While it’s unclear how many firms could potentially qualify for the exemption, workers at any firms that do won’t necessarily be left paying for their pills. “The administration will likely by regulation put some type of work-around in place,” to give workers the benefit, says Tim Jost, a law professor and Affordable Care Act expert at Washington and Lee University. “I just don’t know how long it will take them to do it. They may be prepared to do it very quickly.”

What if I work at a non-profit with a religious affiliation, such as a Catholic hospital or university?

Religious organizations such as churches were already exempt from the requirement that they cover all types of FDA-approved contraception. Separately, religious-affiliated non-profits, including universities and hospitals, were granted a workaround by the Obama administration. Workers in those firms still have access to contraception at no cost. The companies simply turn over the administration and cost to the health insurer. There are legal suits working their way through the court system fighting this accommodation, though. Based on today’s ruling, Jost says it seems that the court may be implicitly saying this work-around is permissible.

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