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Most health insurance plans in Oregon cover a broad range of reproductive health services. In many cases you do not pay anything out-of-pocket. Ask your insurance company for details about what is covered under your plan. Commonly covered services include:
Schedule a wellness visit with your health care provider every year at no cost. This annual wellness visit, also known as a well-woman visit, is an important way to help you stay healthy. Wellness visits include preventive services such as a pelvic exam, breast exam, pap smear, screenings for certain types of cancers, and discussions about reproductive health.
You have the choice to determine the type of birth control or contraceptive you want in consultation with your health care provider. This includes coverage of permanent birth control procedures such as, tubal ligations and vasectomy.
If prescribed by your health care provider, you can receive up to a 12-month supply of a contraceptive following the first three months using that type of contraceptive. Insurers are required to cover any contraceptive drug, device, or product (or the therapeutic equivalent) approved by the U.S. Food and Drug Administration. Delays in receiving birth control due to insurance are generally not allowed, such as requiring you to try a different contraceptive first (step therapy), needing extra time to review the request (prior authorization), or other utilization review techniques.
Screenings for sexually transmitted infections (STIs) are covered under your health insurance plan. Get tested for STIs, such as chlamydia, gonorrhea, hepatitis B, hepatitis C, HIV, human papillomavirus, and syphilis. Make sure the laboratory you go to is in-network with your insurance company to avoid any out-of-network charges.
Many health plans in Oregon cover abortion services, including medication abortion (sometimes called abortion pills). Some plans provide coverage without a copay or coinsurance. Contact your health insurance company to get more information about your plan details. Resources are available in the community to find a reproductive health clinic or to help with cost.
Select this link for more information on these resources to help you access care.
Screenings for cervical cancer and breast cancer are covered under your health plan, as well as counseling and testing for the presence of BRCA genes that may increase your likelihood of developing breast cancer.
Your insurance covers counseling from trained providers, and access to breastfeeding supplies.
Folic acid supplements, gestational diabetes screening, postpartum depression screening, Rh incompatibility screening, and tobacco intervention and counseling are examples of other covered services for those who are or may become pregnant.
Birth control – You have the choice to determine the type of birth control or contraceptive you would like in consultation with your health care provider. This includes coverage of more permanent birth control procedures such as hysterectomy, salpingectomy, and vasectomy.
If prescribed by your health care provider, you can receive up to a 12-month supply of a contraceptive following the first three months using that type of contraceptive. Insurers are required to cover any contraceptive drug, device, or product (or the therapeutic equivalent) approved by the U.S. Food and Drug Administration. Delays in receiving birth control due to insurance are generally prohibited, such as requiring you to try a different contraceptive first (step therapy), needing extra time to review the request (prior authorization), or other utilization review techniques.
Reproductive Health Equity Act
The Reproductive Health Equity Act (RHEA) is an Oregon law that provides for expanded coverage for some Oregonians to access free reproductive health services, especially those who, in the past, may have not been eligible for coverage of these services. It also provides protections for reproductive health services with no cost sharing, such as copays or payments toward deductibles, and prohibits discrimination in the provision of reproductive health services.
Only certain health insurance plans issued in Oregon must cover the services listed above, as well as other reproductive health, sexual health, and other health care services, with no out-of-pocket cost to you. Many health insurance plans do provide access and coverage for reproductive health services. Contact your health insurance company for your plan details on coverage of reproductive health services.
RHEA plan information
A quarterly listing of plans that are subject to the Reproductive Health Equity Act (RHEA).
HIOS plan IDs for 2022 Affordable Care Act plans
Contact a DFR consumer advocate for help
Do you have an insurance complaint? Questions about your health insurance? We have a dedicated team of consumer advocates who are here to help, free of charge. Call us at 1-888-877-4894, email DFR.InsuranceHelp@dcbs.oregon.gov, or
file a complaint online.
Other health insurance resources
If you do not have health insurance, see if you qualify for the Oregon Health Plan (OHP). To apply, call 800-699-9075 (toll-free).
If you have OHP and want to better understand your insurance coverage, call OHP Client Services at 800-273-0557 (toll-free)
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