MONEY Health Care

4 Really Weird Things About the Latest Obamacare Ruling

U.S. President Barack Obama (L) walks out next to Vice President Joseph Biden
Obama's signature health-care law faces a new court challenge. Larry Downing—Reuters

An appeals court says Congress must have meant to make the health care law even more complicated than we thought.

Today two separate appeals courts handed down decisions on challenges to the Affordable Care Act, known popularly as Obamacare. One of those courts, a three-judge panel of the U.S. Court of Appeals for the D.C. Circuit, ruled that the federal government can’t provide insurance premium subsidies to people in states that haven’t set up their own insurance exchanges. The other court rejected that argument.

The D.C. circuit’s opinion, which would invalidate the subsidies paid to about 5 million people, will be a huge, huge deal if it holds up. Much of the early debate and legal wrangling over the ACA focused on the “individual mandate,” the part of law that fines you if you don’t have health coverage. But the subsidies are even more important because they make the required coverage affordable for moderate- to middle-income families. (The subsidies are available to a family of four earning up to $95,400.) The law says you don’t have to pay the fine if insurance isn’t affordable, so without the subsidies the mandate doesn’t apply to so many people.

The ruling could very well be overturned on appeal, and in the meantime the subsidies remain in place. (You can read more on what happens next in this report by Time’s Kate Pickert.) But as a reporter who has covered health care reform closely since the George W. Bush administration, I have to say this ruling just doesn’t make much sense to me. In particular, four very odd things stand out.

1. The court’s interpretation seems implausible.

Quick background: Obamacare subsidies are issued when you buy insurance on an online marketplace called an exchange. Some states set up their own exchanges, but 36 states didn’t, leaving the federal government to do the job instead. The D.C. Circuit ruled that the law authorizes the subsidies to be paid only through state-run exchanges.

This ruling hinges on a close reading of the law, a purported effort to figure out what Congress truly intended. The government, defending Obamacare, argued that because the law can’t work without the premium subsidies, Congress must have meant them to apply regardless of who ran the exchange.

But the court offered another theory: Maybe Congress meant the subsidies to be an incentive for states to set up their own exchanges.

That sounds like a implausibly flexible approach to what was meant to be a sweeping national health care law. After all, it essentially gives any state whose governor or legislature opposes the ACA a chance to opt out of some its biggest provisions—not just the subsidies, but the individual mandate, too.

Cast your mind back to the debate in 2009 and 2010. What I remember was conservatives denying the ACA a single Republican vote and arguing that Democrats would brook no compromise. Democrats, meanwhile, were pointing out that Obamacare looked a lot like the Massachusetts law signed by Republican governor Mitt Romney.

It seems to me that in a long argument over whether Obama and Nancy Pelosi and Max Baucus were tyrants, or just sweetly reasonable splitters-of-the-difference, someone might have said: “Hey, if Republican-led states don’t like the individual mandate, they can always opt out of the exchanges.”

That did not happen.

2. If the ruling stands, this messes up the insurance markets in 36 states.

If there are no subsidies, that doesn’t only mean that many people won’t get help from the government to buy coverage. Even those who didn’t get the subsidies in the first place could face higher prices.

That’s because the law requires the exchanges to sell insurance to everyone who applies, charge them the same rates (based on age) regardless of health, and offer a minimum package of benefits. The problem is that if you don’t have to buy insurance, many people will do so only when they know they need coverage—i.e., when they are sick. And if too few healthy people and too many sick people sign up, insurers have to raise prices to cover the costs. That then means you have to really sick to want to sign up, and that jacks up rates more, and so on. This is known in insurance as adverse selection, or a “death spiral.”

So the federal exchanges could stop working pretty quickly if this ruling stands. In fact, according to the briefs filed by the insurance industry and a group of economists who support the ACA, the adverse selection problem in the exchanges could spill over into the market for private individual plans outside the exchange too, since the law links the two markets in various way. How this would actually play out is unclear, but suffice it say, it’s a major rug-pulling.

Setting up federal exchanges that can’t work seems pretty dumb. Now, as Michael Cannon of the libertarian Cato Institute says, it’s not like lawmakers never make bad laws. States have tried to regulate insurance coverage the way the ACA does, without subsidies, and they’ve run into all these adverse selection problems. The thing is, people in Washington knew this when the ACA was being debated and written. It’s why the subsidies and the individual mandate—a wildly controversial, politically costly provision that many members of Congress wished would go away—were in the law in the first place.

3. This somehow involves the Northern Mariana Islands.

The D.C. Circuit panel notes that the ACA in fact did trigger the “death spiral” problem in this U.S. overseas territory in the Pacific. That’s because the Northern Mariana Islands were subject to the new rules about health coverage but left out of the subsidies. That, says the court, means that maybe Congress really could have meant to regulate the insurance market without subsidizing it too.

I can think of some other reasons why Congress might have klutzed up the part the law that applies to U.S. territories. Like the fact that people in those places have no voting representation in Congress.

4. Congress really isn’t very good at crafting laws

I don’t mean it’s not good at making laws (views may vary on that). I’m talking about the actual writing-it-down part. The court’s lead opinion is devastating in showing how badly written parts of the law are. If these were comments from the professor in a course titled “Lawmaking 101: Making a Bill a Law,” you’d expect to see a big fat red “D” at the bottom of Congress’ term paper. The bill was pushed through hastily after Republican Scott Brown unexpectedly won the late Ted Kennedy’s seat in the Senate, depriving the Democrats of a filibuster-proof majority. The craziness of the legislative process shows in the text.

But its not just a craft problem. The legal vulnerability of the ACA goes hand-in-hand with how politically vulnerable it is. The law makes sense in a basic way and seems to be helping more people get coverage. And polls say people like many of the provisions of the law. But it is also complicated, and hinges on many different players (states, employers, private insurers, Medicare, Medicaid, you and me…) interacting in predictable and not-so-predictable ways. From the beginning, many people have really struggled to get how the law fits together. Turns out that may have included some people in Congress.

TIME Health Care

What the New Obamacare Court Decisions Mean for You

U.S. President Barack Obama speaks before signing the H.R. 803, the Workforce Innovation and Opportunity Act. during an event in the Eisonhower Executive Building, July 22, 2014 in Washington, DC.
U.S. President Barack Obama speaks before signing the H.R. 803, the Workforce Innovation and Opportunity Act. during an event in the Eisonhower Executive Building, July 22, 2014 in Washington, DC. Mark Wilson—Getty Images

Two federal courts, two conflicted rulings. What does it all mean?

On Tuesday, two federal courts issued rulings on President Obama’s healthcare law. Here’s what you need to know about how the rulings affect you:

What did the courts say?

A panel in the D.C. Circuit Court of Appeals ruled that the Affordable Care Act (ACA) does not allow the federal government to distribute insurance subsidies through a federal exchange being used in 36 states. Many states declined to set up their own insurance exchanges, forcing the federal government to set up its own central exchange where subsidized plans are sold. The D.C. court said that only people living in those states with their own exchanges are eligible for federal subsidies, due to ambiguities in the language of the ACA.

But in the Fourth Circuit Court of Appeals, judges reached the opposite conclusion. That panel ruled that the federal government does have the authority to hand out insurance subsidies through the federal exchange, and always intended subsidies to be available to any eligible individual in the U.S., regardless of who is running the exchange.

What happens next?

The federal government will appeal the D.C. court ruling and plaintiffs in the identical case in the Fourth Circuit will also likely appeal. The issue is likely to remain unsettled for many months.

What does this mean for Americans currently getting insurance through the ACA?

Nothing yet. With conflicting rulings on the same day and appeals certain, the status quo will remain in place — for now.

But if the D.C. ruling ends up being upheld and the Fourth Circuit overturned, the consequences would be immense. By 2016, more than 7 million people are set to receive ACA insurance subsidies through the federal exchange at the center of each of Tuesday’s rulings. These subsidies are now under threat, and could disappear in those 36 states if the D.C. ruling is upheld on appeal.

Without subsidies, millions in those states could see their insurance premiums go up dramatically. The ACA requires most Americans to have health insurance but only if they can afford it. Without subsidies, coverage for millions would become unaffordable. Removing these people from the health insurance pool could destabilize premiums for everyone else.

What would that mean for Obamacare?

It would be a hammer blow, if the D.C. ruling stands. The government would no longer be able to distribute insurance subsidies in those 36 states, unless those states opted to set up their own exchanges. That would be unlikely, since many of the states that declined to set up exchanges did so in protest at the ACA. The subsidy system is a central feature of Obamacare and Democrats’ plan to expand insurance coverage to low- and middle-income Americans.

Opponents of the law have sued over the ACA before. What makes this case different?

A ruling that threatens to strip insurance subsidies from millions of Americans is the most significant threat to Obamacare since it overcame the challenge to its constitutionality in the U.S. Supreme Court in 2012 — though that same ruling made its Medicaid expansion optional and not mandatory, blocking millions of low-income Americans from coverage. Legal arguments made against Obamacare since have not struck at the heart of the law’s goal of expanding coverage. The recent Hobby Lobby lawsuit, for example, only affected contraception coverage for some employer health plans.

MONEY Health Care

Why Your Spouse Could Start Costing You More At Work

Wedding rings with health cross on them
Burazin—Getty Images

As health care costs climb, firms are rethinking how much they should spend on coverage for their workers’ husbands and wives.

Q. I hear my company will start charging even more for my spouse to sign up for my health insurance. Why is that?

A. This summer, companies are busy choosing health plans for 2015. And the discussions in the boardrooms are about as heated as the air outside the office, according to Randall Abbott, a senior consultant with Towers Watson. Abbott has been in nearly a dozen meetings in the past three weeks that have addressed one particularly fraught topic: how much companies shell out for health care for their workers’ spouses.

Struggling to rein in health care spending and worried about having exceptionally rich benefits that trigger Obamacare’s so-called Cadillac tax in a few years, businesses are looking for ways to pare back insurance costs. And spousal coverage is often floated as a possible cutback, Abbott says. Many firms have figured out that they spend at least as much—and often more—on coverage for spouses than they do on the workers themselves, so they are rethinking the approach to coverage.

That could mean a higher health insurance premium next year. Just how much higher won’t be clear until this fall, when you sign up for next year’s plan.

“It is a very charged topic,” says Abbott. “Many organizations have prided themselves on being family friendly, and they talk about their employees and family as part of the corporate family, but actions like this are starting to restate the deal between employers, employees, and family members.”

Businesses are not required to offer coverage to spouses—though most large firms do.

Many companies have already been passing on higher costs, hoping spouses will think twice before jumping onto the employee’s plan. This year, half of firms with more than 1,000 workers had spouses pay more for their health premium than workers do, according to Towers Watson’s research.

One-quarter of large firms charge spouses more for coverage when they have access to employer-sponsored coverage at their own job but turn it down. Another 15% plan to go that route in 2015. How much more? On average, couples pay an extra $1,200 a year.

“We think the surcharge will grow not necessarily because all employers think it is a great idea, but it almost becomes a defensive measure to make sure your plan doesn’t become a dumping ground for spouses,” says Abbott.

Some employers require spouses with other coverage options to sign up for that employer plan. Ten percent of firms used that strategy this year, and 13% plan to add the rule next year.

Of course it isn’t always possible for a firm to know if a spouse has access to an employer-sponsored plan through his or her own job. “It is generally done on the honor system,” says Abbott. But if your spouse submits a claim, that may offer clues. For example, a work-related accident might reveal that he or she works at a large firm, where benefits are typically offered.

Only 2% of large companies have stopped paying any of the premium for spousal coverage.

While most of the attention so far has been on partners and spouses, employers are also eyeing what they spend on coverage for workers’ children. Previously most large firms had two rates: individual and family. Now the lineup at most companies includes an individual, couple, and family rate. A few even go as far as to base your premium on the number of children in your family. “This has become one more plan feature that is enormously important for employees and their spouses to understand,” Abbott says.

MONEY Health Care

How to Get the Same Health Care at a Quarter of the Cost

Bandaids with different pricing
Even within your insurer's network, prices for the same service often vary by 300%. Sarina Finkelstein—Ales Veluscek/Getty Images

The prices for getting tested and treated are all over the map. To save on your medical bills, learn to shop smarter.

You know that visiting doctors and hospitals outside your insurer’s network is pricey. What might surprise you is how big a bill you could face even when you stay in network. In a recent analysis of 93 types of services and procedures, Change Healthcare, a company that tracks medical claims, found that in-network prices for the same service often vary by 300% and can differ by as much as 750%.

Picking the higher-price option can cost you: You’ll typically owe full fare until you meet your ­deductible, and then usually a percentage of the bill. “Most people assume if you go in-network everyone is paid the same, so the financial implication for you will be the same,” says Douglas Ghertner, CEO at Change Healthcare. “But that is absolutely not the case.”

Your insurer or employer probably has a web tool that lists what you’ll pay for certain services at local providers, factoring in your deductible and co-insurance. Use it. For these types of care in particular, the swings in insurers’ negotiated in-network rates are wide—and you may have time to shop around.

Imaging: $511 to $2,815 for an MRI; $307 to $2,747 for CT scan

Imaging bills typically run two to three times higher at hospitals than at freestanding radiology centers, according to health insurer Cigna. At hospitals, says Brian Keigley, founder of price-comparison firm New Choice Health, “radiology is often subsidizing other service lines.” Ask your doctor for options other than the hospital (or the MRI machine his practice owns). When comparing costs, confirm that the price includes a pro to read the scan. Check that the facility is ACR-accredited, says Keigley, and make sure your doctor will accept the results.

Specialists: $67 to $207 per visit

When you need a specialist such as a cardiologist or neurologist, you frequently end up seeing whomever your primary-care doctor recommends. But you ought to know what’s behind the suggestion. Often he or she will refer you within the same health system, says Christine Riedl of health insurer Aetna. Ask your doctor how crucial it is to see this specialist vs. another MD, and get a few additional names. For common specialties, your plans’ pricing tool most likely factors in quality metrics by practice, so you can see if the one charging less meets those standards.

Physical therapy: $620 or $2,280 for 10 sessions

Hospital facilities often negotiate higher prices with insurers than standalone PT practices do, says Justin Moore of the American Physical Therapy Association. If your doctor suggests a therapist, find out if he or she specializes in your condition. Check on how many visits you’ll need, the cost per visit (some pricing tools do not include PT), and what you’ll owe (confirm that with your insurer). Ask what signs will indicate progress, such as being able to walk down a hallway in X amount of time. Says Moore: “Being able to spell that out is an indication of the quality of care.”

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 Barack Obama

Obama’s ‘Between Two Ferns’ Episode Nominated for an Emmy

Obama Visits Tech Hub
U.S. President Barack Obama speaks about the economy at the technology start-up hub "1776" July 3, 2014 in Washington, DC. Pool—Getty Images

Obama himself won't get an Emmy, though

An episode of online comedy series “Between Two Ferns with Zach Galifianakis” featuring President Barack Obama was among the Emmy nominees announced Thursday morning.

The six-minute, 30-second episode featuring the President has been nominated for Outstanding Short-Format Live-Action Entertainment Program. It was first published on the humor website Funny or Die on March 11. Galifianakis’ show sees the actor interview a string of famous guests whom he asks inappropriate and awkward questions.

Though Galifianakis is biting, he’s no match for the President who, when asked if he wishes he could run a third time, replies: “Uh, if I ran a third time, it’d be sorta like doing a third Hangover movie. It didn’t really work out very well, did it?”

Obama then proceeds to try and educate Galifianakis about the Affordable Care Act and registering with online or by phone. Galifianakis responds: “I’m off the grid. I don’t want you people, like, looking at my texts.”

While Obama himself is not up for an Emmy for the episode, he has previously received the Grammy for best spoken word album for Dreams from My Father and The Audacity of Hope in 2006 and 2008, respectively.

The 66th Primetime Emmy Awards will be broadcast on August 28 at 8 p.m. ET on NBC. Actor Seth Meyers is hosting this year’s awards.

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.


Three Ways to Cut the High Costs of Infertility

Portrait of newborn girl (0-1months) with mother
Mike Kemp—Getty Images/Brand X

These steps can substantially lower your out-of-pocket costs for infertility treatment.

Medical bills for couples struggling to have a baby can mount quickly, particularly if you’re pursuing higher tech procedures, such as in vitro fertilization. According to one recent study, the typical couple being treated for infertility spends about $5,300 out of pocket, while those undergoing IVF shell out roughly $19,200 for their first attempt and nearly $7,000 for each subsequent IVF cycle (several are often needed).

These steps can help you lower the tab, and possibly increase your chances of success.

Make the right match. “The most effective way to minimize costs is to maximize your chance of success from the first attempt,” says Mindy Berkson, a Chicago infertility consultant who advises couples on costs and treatment. Your best option may not be a local clinic or the one with the lowest cost, says Berkson. Don’t choose a clinic based only on its published success rates (find those stats from the Centers for Disease Control site here). A medical facility that accepts patients with harder-to-treat issues will have lower success rates overall but may be better equipped to treat your problem. “The better question to ask is, ‘What are my chances of success with my specific diagnosis?’” says Berkson, who is president of Lotus Blossom Consulting. A helpful resource: The Society for Assisted Reproductive Technology, which lists clinics’ experience with particular procedures as well as success rates by the age of patient.

Check your insurance coverage. Don’t leave it up to the clinic’s business office to determine if your plan will cover your treatment. “The clinic won’t push,” says Davina Fankhauser, founder of Fertility Within Reach, an infertility benefits specialist. “You have to be your own advocate.” Read your insurance policy carefully. Then talk to your HR department and your insurer to make sure you understand exactly what’s covered, what’s excluded, and whether treatment costs are capped (a maximum is common). If your health insurance doesn’t provide infertility benefits, there may be another plan offered at your company that does (though you’ll need to wait until open enrollment season to make a switch.)

Get the right coding. Many insurers won’t pay for infertility treatment since it’s often deemed medically unnecessary. But they will cover the costs of treating underlying medical conditions, such as endometriosis, that may be at the root of the problem to conceive, notes Fankhauser. Talk to your doctor about the diagnostic code that will be submitted to your carrier. If you claim is denied for a procedure that you believe should be covered, file an appeal with your insurer. Still no success? File an external appeal with your state’s department of insurance.

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.

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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