IUDs
Illustration by Miles Donovan for TIME

Should you use birth control pills, condoms or an intrauterine device (IUD)? Women choose their birth control based on many factors, like effectiveness or comfort—but cost has been less of a consideration, ever since the Affordable Care Act. A provision in the act required employers to provide contraception to all women in their health plans without charging a copay or coinsurance fee. Estimates suggest that more than 55 million women had access to birth control without co-pays because of the mandate.

Going forward, the price of birth control may matter more. On Oct. 6, President Donald Trump rolled back that coverage and issued a new rule that offers exemptions for any employer, regardless of industry, who objects to offering contraception coverage due to his or her personal religious beliefs or moral convictions.

Experts don’t yet know what effect the new rule will ultimately have on women’s ability to access birth control. But some worry that the IUD—one of the most effective and low-maintenance types of birth control—could become prohibitively expensive. Without insurance, it’s one of the priciest methods up front, costing about $900. And though an IUD may be a better financial investment over time, since women can use the device for several years, such a high initial price tag is beyond the means of many women.

Health care analytics company Amino analyzed billions of health insurance claims from 2014 to mid-2017 to understand how much an IUD could cost women if their insurance no longer covered it. They analyzed the Mirena and the Skyla IUD, which use the hormone progestin, and the ParaGard IUD, a non-hormonal copper-releasing device.

On average, an IUD could cost about $1,000 out of pocket across the country, the group reported. Below is an interactive map using data from Amino of what the typical cost of an IUD could be in each state. (The price estimates are for the total cost of an IUD, including the insertion procedure.)

Cost of IUDs by State
MACTDCRIDE$1,494$937
Click a state to see the cost and rank.

Source: Amino

As the data show, the lowest estimated cost is about $800. “[An IUD] is not cheap, and the median price is well outside affordability for many women,” says Sohan Murthy, a data scientist at Amino.

Compared to the condom, which has a typical use failure rate of 18%, or the birth control pill, which has a failure rate of 9%, the IUD has a failure rate of 0.8% or less. IUDs also require little to no maintenance for years, and hormone-free versions are available. Once IUDs became more affordable under the ACA, public health groups across the nation launched public awareness campaigns to encourage more women to consider using long-acting reversible contraception like the IUD.

The method is growing more popular. About 6% of women in the U.S. had tried the method in 2002, but that grew to 15% in 2011-2015. Studies have also shown that when women have access to all forms of birth control without financial barriers, they are more likely to choose the kind that’s most effective. A long-term study based out of St. Louis called the The Contraceptive CHOICE Project enrolled nearly 10,000 women and found that when the women were counseled about all methods of birth control, 75% chose a long-active reversible method, like the IUD.

Even before the new rule was announced, many women sought IUD consultations with providers, potentially in anticipation of changes to insurance coverage of birth control. A January report found that the number of women who visited their physician to discuss the birth control method rose nearly 19% after Donald Trump was elected as President.

Methodology

Data is from Amino. Cost per state is determined by taking the median cost of the three types of IUDs in each state.

http://time.com/4985605/iud-birth-control-health-insurance/