Health & Spirit

Maryland offers many insured men free vasectomy coverage

Michelle Andrews, Kaiser Health News on

Published in Health & Fitness

It was a well-intentioned effort to provide men with some of the same financial protection from birth control costs that women get. But a new Maryland law may jeopardize the ability of thousands of consumers -- both men and women -- to use health savings accounts.

The law, which took effect Jan. 1, mandates that insurers cover vasectomies without requiring patients to pay anything out-of-pocket -- just as they must do for more than a dozen birth control methods for women.

But the measure may run afoul of Internal Revenue Service rules that do not include vasectomies among approved preventive services for high-deductible health plans. People with health savings accounts -- which are exempt from tax liabilities -- tied to those plans could no longer contribute to the savings accounts in that case.

Under the Maryland Contraceptive Equity Act, insurers generally can't charge patients a copayment or require any other cost sharing for prescription contraceptive drugs or devices approved by the Food and Drug Administration. The 2016 law is similar to what's required under the federal Affordable Care Act, with a twist: It adds male sterilization -- vasectomies -- to the list of services that are free for patients.

"While the ACA made important strides ... it completely left men out of the equation," said Karen Nelson, president and CEO of Planned Parenthood of Maryland, whose organization supported the bill.

Before the law took effect, a vasectomy at the organization's Baltimore office would cost between $225 and $1,100, depending on someone's ability to pay, said Nelson. Now the procedure will generally cost nothing for men in insured plans in Maryland.

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The state law doesn't apply to companies that are "self-funded," meaning they pay their employees' health care claims directly rather than buying state-regulated insurance policies.

Under IRS rules, consumers making tax-free contributions to health savings accounts (HSAs) that are linked to high-deductible health plans have to pay for all their medical care until they reach their deductible of at least $1,350 for individuals and $2,700 for families in 2018. The only exception is for preventive services. The hitch for the Maryland law is that vasectomies aren't on the IRS list of approved preventive services.

The IRS hasn't responded to a request for clarification by Maryland Insurance Commissioner Al Redmer Jr. A bill was reintroduced this year -- after it failed to pass last year -- that would exempt these high-deductible plans from the state mandate to cover vasectomies before the deductible is met. Such a move would preserve the tax advantages of the HSAs linked to them.

Maryland is joining a few other states, including Illinois, Vermont and, starting next year, Oregon, that have expanded contraceptive coverage without cost sharing to include male sterilization.


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