Repro Health Coverage Spreadsheet
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BIRTH CONTROL
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PLANS/PROGRAMSIncome Limit/Ages CoveredPhoneNotesPlan OptionsPatchRingCervical CapPillCondomsDiaphragmSpongeSpermicideImplantable RodIUDTubal LigationVasectomyInjectionEC
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CHiP - Children's Health Insurance Program - YOU CAN CHOOSE FROM ONE OF THE THREE PLANS LISTED HERE TO THE RIGHT ++You may be able to get coverage for something not listed here if your physician requests that.++http://www.chipcoverspakids.comChildren and Teens through age 18. Free or subsidized depending on income and family size. 1-800-986-KIDS (5437)Get Help Applying from an Organization Listed Below or Apply Yourself Online at http://www.compass.state.pa.us/UPMC for KIDS 1-800-978-8762XulaneNuvaringN but may be covered if Dr. requestsSprintec, Tri-Sprintec, Apri, Aranelle, Enpresse, Lessina, Levora, possibly others - call for infoN but may be covered if Dr. requestsN but may be covered if Dr. requestsN but may be covered if Dr. requestsN but may be covered if Dr. requestsN but may be covered if Dr. requestsN but may be covered if Dr. requestsN but may be covered if Dr. requestsN but may be covered if Dr. requestsMedroxyprogesterone, Depo ProveraLevonorgestrel, Next Choice, Plan B (Must have prescription in PA for Medical Assistance coverage. Over the counter without prescription if paying for it yourself.)
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CHiP - Children's Health Insurance Program - YOU CAN CHOOSE FROM ONE OF THE THREE PLANS LISTED HERE TO THE RIGHT ++You may be able to get coverage for something not listed here if your physician requests that.++http://www.chipcoverspakids.comChildren and Teens through age 18. Free or subsidized depending on income and family size. 1-800-986-KIDS (5437)Get Help Applying from an Organization Listed Below or Apply Yourself Online at http://www.compass.state.pa.us/KEYSTONE HEALTH PLAN WEST Highmark Blue Cross Blue Shield 1-800-543-7105Ortho Evra, Xulane, May be copay-freeNuvaring, May be copay-freeLots of options, call for info, May be copay-freeMultiple kinds of Kimono, Trustex, May be copay-freeOrtho, Caya, Wide Seal, May be copay-freeToday, May be copay-freeConceptrol, Gynol II, VCF, May be copay-freeImplanon, Nexplanon, May be copay-freeParagard, Kyleena, Liletta, Mirena, Skyla, May be copay-freeMedroxyprogesterone, Depo Provera, May be copay-freePlan B, Ella, Many Generics, May be copay-free
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CHiP - Children's Health Insurance Program - YOU CAN CHOOSE FROM ONE OF THE THREE PLANS LISTED HERE TO THE RIGHT ++You may be able to get coverage for something not listed here if your physician requests that.++http://www.chipcoverspakids.comChildren and Teens through age 18. Free or subsidized depending on income and family size. 1-800-986-KIDS (5437)Get Help Applying from an Organization Listed Below or Apply Yourself Online at http://www.compass.state.pa.us/UNITED HEALTHCARE COMMUNITY PLAN FOR KIDS 1-800-414-9025XulaneNuvaringXLots of options, call for infoY, Latex lubricated generic.Y - Wide Seal.XShur Seal, VCF VaginalXKylena and Makena may be covered.XXMedroxyprElla, My Way, Levonorgestrel, Take Action, Next Choice, Fallback, Opcicon, Econtra EZ, Aftera, React, Option 2, Plan B (Must have prescription in PA for Medical Assistance coverage. Over the counter without prescription if paying for it yourself.)
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MEDICAL ASSISTANCE - MEDICAID - YOU CAN CHOOSE FROM ONE OF FOUR PLANS LISTED HERE TO THE RIGHT - see https://www.enrollnow.net/ ++You may be able to get coverage for something not listed here if your physician requests that.++http://www.dhs.pa.gov/citizens/healthcaremedicalassistance/Age 19-64, Under 133% of the Federal Poverty Level = $15,800 for a single person, add approx. $6,000 per person for other family sizes866-550-4355Get Help Applying from an Organization Listed Below or Apply Yourself Online at http://www.compass.state.pa.us/UPMC for You 1-800-286-4242Xulane, Ortho EvraNuvaringXhttps://www.upmchealthplan.com/docs/members/Pharm-GD_MA.pdf - Lots of optionsXXXXXMirena, Skyla ?XXMedroxypr, Depo ProveraLevonorgestrel, Next Choice, (Must have prescription in PA for Medical Assistance coverage. Over the counter without prescription if paying for it yourself.)
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MEDICAL ASSISTANCE - MEDICAID - YOU CAN CHOOSE FROM ONE OF FOUR PLANS LISTED HERE TO THE RIGHT - see https://www.enrollnow.net/ ++You may be able to get coverage for something not listed here if your physician requests that.++http://www.dhs.pa.gov/citizens/healthcaremedicalassistance/Age 19-64, Under 133% of the Federal Poverty Level = $15,800 for a single person, add approx. $6,000 per person for other family sizes866-550-4355Get Help Applying from an Organization Listed Below or Apply Yourself Online at http://www.compass.state.pa.us/United Healthcare Community 1-800-414-9025XulaneNuvaringXLots of options, call for infoY, Latex lubricated generic.Y - Wide Seal.XShur Seal, VCF VaginalXKylena and Makena may be covered.XXMedroxyprElla, My Way, Levonorgestrel, Take Action, Next Choice, Fallback, Opcicon, Econtra EZ, Aftera, React, Option 2, Plan B (Must have prescription in PA for Medical Assistance coverage. Over the counter without prescription if paying for it yourself.)
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MEDICAL ASSISTANCE - MEDICAID - YOU CAN CHOOSE FROM ONE OF FOUR PLANS LISTED HERE TO THE RIGHT - see https://www.enrollnow.net/ ++You may be able to get coverage for something not listed here if your physician requests that.++http://www.dhs.pa.gov/citizens/healthcaremedicalassistance/Age 19-64, Under 133% of the Federal Poverty Level = $15,800 for a single person, add approx. $6,000 per person for other family sizes866-550-4355Get Help Applying from an Organization Listed Below or Apply Yourself Online at http://www.compass.state.pa.us/Aetna Better Health (866) 638-1232 XulaneNuvaringPrentifLots of options, call for infoAtlas, Elexa, Kimono, Maxx, Reality, Trojan-EnzOmni-Flex, Wide SealXXXParagard, Kyleena, Liletta, Mirena, SkylaXXMedroxyprElla, Fallback, Levonorgestrel, My Way, Next Choice, Take Action (Must have prescription in PA for Medical Assistance coverage. Over the counter without prescription if paying for it yourself.)
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MEDICAL ASSISTANCE - MEDICAID - YOU CAN CHOOSE FROM ONE OF FOUR PLANS LISTED HERE TO THE RIGHT - see https://www.enrollnow.net/ ++You may be able to get coverage for something not listed here if your physician requests that.++http://www.dhs.pa.gov/citizens/healthcaremedicalassistance/Age 19-64, Under 133% of the Federal Poverty Level = $15,800 for a single person, add approx. $6,000 per person for other family sizes866-550-4355Get Help Applying from an Organization Listed Below or Apply Yourself Online at http://www.compass.state.pa.us/Gateway Health Plan (800) 392-1147 It's difficult to get info on Gateway's coverage. Call with a specific device or drug name to confirm. Gateway Medicaid does allow coverage of some items by request from your physician.XNuvaringXMany options, call for infoXXXXNexplanonMirena and ParagardXXXMy Way, Next Choice (Must have prescription in PA for Medical Assistance coverage. Over the counter without prescription if paying for it yourself.)
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PA FAMILY PLANNING SERVICEShttp://dhs.pa.gov/citizens/reproductivehealth/familyplanningUnder 215% of the Federal Poverty Level = $25,929 for a single person, add approx. $9,000 per person for other family sizes; are not otherwise eligible for Medical Assistance;
are not pregnant;
are residents of Pennsylvania; and,
are U.S. citizens or if not U.S. citizens, have a satisfactory immigration status and identification. For men, women and teens. 18-65. Free or low-cost.
1-800-537-8862 FPS is for people who don't already have insurance, or have insurance that they can't use due to confidentiality/safety issues, or who have insurance but it doesn't cover birth control - (Catholic institutions' insurance, for instance) Coverage will begin on the application date (if you sign up at a provider - can be delay if sign up online)http://dhs.pa.gov/citizens/reproductivehealth/familyplanning/index.htmXulane Patch and Ortho Evra NuvaringXCombined - many covered; Progestin-only - 5 types covered; Extended/Continuous Use - 2 coveredYYXXNexplanonMirena and ParagardXPossiblyDepo-SubQ ProveraElla and Levonorgestrel
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ACA PLANS (OBAMACARE)https://www.healthcare.gov/Subsidies reduce cost at certain income levels. These forms of BC are free with no copay even if deductible not yet met. "New HHS clarification on ACA contraceptive coverage requirement specifies that insurance plans must cover at no cost to women all of the 18 contraceptive methods approved by the FDA. If a provider recommends a specific option or product, plans must cover it at no cost as well."211 - make appointment with a health insurance navigator near you. Other ACA navigator resources: Consumer Health Coalition: 412-456-1877
PA Health Access Network: 1-877-570-3642
http://www.kff.org/womens-health-policy/issue-brief/minimum-contraceptive-coverage-requirements-clarified-by-hhs-guidance/Must cover at least 1 kind (May be generic)Must cover NuvaRingOnly FemCap available, must coverCombined - must cover at least 1; Progestin-only - must cover at least 1; Extended/Continuous Use - must cover at least 1 (These can be generic)NOnly Milex Omniflex available, must coverOnly Today available, must coverMust cover at least 1 kind (May be generic)Must cover at least one kindCopper - Must cover ParaGard; Progestin - must cover at least 1 kindMust cover; Implant sterlization - Must cover EssurePlans not required to cover, check w planMust cover at least 1 kind (May be generic)Progestin - must cover at least 1 kind (These contain levonorgestrel eg Plan B); Ulipristal Acetate - only Ella available, must cover
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PROVIDERS (selection)
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ProviderPhone/AddressWebsitePlans/Programs
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Planned Parenthood of Western PAMultiple locations - Downtown is at 933 Liberty Ave., Pgh 15222, 412-434-8971www.ppwp.orgMedical Assistance, Family Planning Services, ACA - Most Major Health Insurance Plans, Sliding Scale for Uninsured
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Adagio LocationsMultiple locations - 1.800.215.7494www.adagiohealth.orgMedical Assistance, Family Planning Services, ACA - Most Major Health Insurance Plans , Adagio does sliding scale care for Uninsured
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Allegheny Reproductive Health Center5910 Kirkwood St., Pgh 15206, 412-661-8811http://www.alleghenyreproductive.comACA - Most Major Health Insurance Plans
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The Midwife Center2831 Penn Ave. Pgh 15222, 412-321-6880www.midwifecenter.orgMedical Assistance, Family Planning Services, ACA - Most Major Health Insurance Plans, Sliding scale for Uninsured
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OTHER RESOURCES/INFO
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Help Applying for and Navigating CHiP, Medical Assistance and ObamacarePennsylvania Health Law Project - free legal help and advice: www.phlp.org or (800) 274-3258.Consumer Health Coalition - www.consumerhealthcoalition.org or 412.457.1877
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Cheap Generic Birth Control PillsSprintec @$10/month (generic similar to Ortho-Cyclen® * / Estarylla / Mononessa / Previfem)Target - $9/28 pills Sprintec and Tri-SprintecRX Outreach - 6 months $65 http://rxoutreach.org/find-your-medications/
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Free CondomsDowntown: Planned Parenthood (address above) - walk in, don't need apptEast Liberty: Pittsburgh AIDS Task Force - Walk in and take handful, they can also give people a bag with more or if people need a special kind they can look into that Lawrenceville: Persad, walk in and take a handful from container in lobby
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Cheapest EC Out of Pocket PghThe Midwife Center $25, see address above(Or use birth control pills - http://ec.princeton.edu/questions/dose.html)
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Help with Birth Control Coverage Problemshttps://nwlc.org/having-trouble-getting-birth-control/https://nwlc.org/coverher/
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Birth Control Infohttps://www.bedsider.org/
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Emergency Contraception Infohttp://ec.princeton.edu/emergency-contraception.html
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