Closing the Contraception Coverage Gap Act

Bill Number: S. 3560
Origin Chamber: Senate
Congress: 119th Congress, Session 1
Policy Area: Health
Status: Introduced
Latest Action: 2025-12-18: Read twice and referred to the Committee on Finance.
Last Updated: 2026-01-21T08:03:47Z

AI-Generated Summary

Summary of S. 3560: Closing the Contraception Coverage Gap Act

Purpose

This bill aims to expand Medicare coverage to include contraceptive items and services without any out-of-pocket costs (known as "cost-sharing," which includes deductibles, copayments, or coinsurance) for eligible beneficiaries. It seeks to align Medicare with existing requirements under the Affordable Care Act (ACA) for private health insurance, closing a gap in access to preventive reproductive health care starting January 1, 2027. Additionally, it directs studies to evaluate and improve access to contraceptives in Medicare and other health programs.

Key Provisions

Medicare Part B Coverage (Traditional Medicare):
Adds "contraceptive items and services" as a covered benefit under Part B, which covers outpatient services like doctor visits and preventive care.
Defines these as items and services provided by a doctor or qualified practitioner that align with federal guidelines (from the Public Health Service Act) for contraception, including counseling, examinations, device insertion/removal, ultrasounds, pain management, follow-up care, and education.
Coverage applies regardless of whether the service is used specifically for contraception (e.g., it could cover related exams for other reasons).
Requires full payment by Medicare (100% of the approved amount) with no deductible or cost-sharing.
Excludes coverage if not ordered by a qualified provider.
Allows the Secretary of Health and Human Services (HHS) to develop quality measures, such as surveys, to ensure effective counseling and access.

Medicare Part C Coverage (Medicare Advantage Plans):
Requires these private plans to cover contraceptive items and services without cost-sharing, treating them like other preventive services under the ACA.
Applies to plan years starting January 1, 2027.

Medicare Part D Coverage (Prescription Drug Plans):
Mandates inclusion of contraceptive drugs (e.g., birth control pills) on formularies (lists of covered drugs).
Provides no deductible or cost-sharing for these drugs, even for low-income beneficiaries.
Applies to plan years starting January 1, 2027, and extends to over-the-counter options in related studies.

Protections for Dual Eligibles (Medicare and Medicaid Beneficiaries):
Ensures Medicare's contraceptive coverage is at least as comprehensive as state Medicaid plans, based on annual HHS reviews.

Studies and Reports:
HHS Study (Section 3): Examines access to prescription drugs, including oral contraceptives, for disabled Medicare beneficiaries not in Medicare Advantage or Part D; also explores no-cost coverage for over-the-counter contraceptives. Report to Congress within 1 year of enactment, with recommendations.
GAO Study on Coverage Gaps (Section 4): Reviews health plans (commercial, Medicaid, Medicare, TRICARE) not required to cover all FDA-approved contraceptives or waive cost-sharing. Report to Congress within 1 year, with recommendations.
GAO Study on Dual Eligibles (Section 5): Analyzes differences in contraceptive coverage between Medicare and Medicaid for dual-eligible individuals. Report to Congress within 2 years, with recommendations.

Significant Changes to Existing Law

Amends the Social Security Act (Titles XVIII for Medicare Parts A-D) to explicitly include contraceptives as a covered benefit, which were previously not guaranteed without cost-sharing in Medicare (unlike in ACA-compliant private plans or Medicaid).
Removes barriers like deductibles and coinsurance specifically for these services, expanding preventive care without altering general Medicare payment structures.
Introduces new definitions (e.g., "ancillary clinical services" for related procedures) and aligns with ACA guidelines issued by January 12, 2022, for evidence-based contraceptive options.
Adds exclusions only for services not provided by qualified professionals, while broadening coverage to include follow-up and counseling on all options.

Potential Impacts

On Citizens: Improves access to affordable contraception for Medicare beneficiaries (primarily those 65+ or disabled), potentially reducing unintended pregnancies, health costs, and barriers for women in rural or low-income areas. Could benefit up to millions, especially older women or those with disabilities facing higher reproductive health needs.
On Government Agencies: HHS must implement changes, issue guidance on counseling, conduct reviews for dual eligibles, and perform a study—potentially increasing administrative workload and costs (though offset by preventive health savings). The Government Accountability Office (GAO) will lead two studies, informing future policy.
On International Relations: No direct impact, as this is a domestic health policy focused on U.S. Medicare.

Main Stakeholders Affected

Medicare Beneficiaries: Primary beneficiaries, especially women of reproductive age with Medicare due to disability, end-stage renal disease, or age 65+.
Healthcare Providers: Doctors, practitioners, and clinics providing contraceptive services, who gain clearer reimbursement rules.
Pharmaceutical and Device Manufacturers: Companies producing contraceptives, as coverage may boost demand for FDA-approved products.
Insurers and Plans: Medicare Advantage and Part D plan administrators must update benefits and formularies.
Government Entities: HHS (implementation and study), GAO (studies), Congress (receiving reports), and states (via Medicaid alignment for dual eligibles).
Advocacy Groups: Organizations focused on reproductive health, women's rights, and disability access, who may influence or monitor implementation.

Notable Legal, Constitutional, or Political Implications

Legal: Builds on ACA precedents by extending no-cost preventive coverage to Medicare, potentially reducing litigation over access disparities. Requires HHS guidance to ensure compliance with existing federal contraceptive recommendations, avoiding conflicts with FDA approvals.
Constitutional: Could face challenges under the Religious Freedom Restoration Act if providers or plans claim burdens on religious beliefs (similar to past ACA contraception mandate cases), though the bill does not address exemptions explicitly.
Political: Bipartisan sponsorship (Democrats and Republicans) signals cross-aisle support for reproductive health access. May influence broader debates on Medicare expansion and preventive care funding, with studies providing data for future reforms without immediate mandates. Referred to the Senate Finance Committee, indicating focus on fiscal and health policy implications.

This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.

Sponsor

Sen. Hassan, Margaret Wood [D-NH]

Cosponsors (3)

Sen. Murkowski, Lisa [R-AK], Sen. Duckworth, Tammy [D-IL], Sen. Collins, Susan M. [R-ME]

Recent Actions

2025-12-18: Read twice and referred to the Committee on Finance.
2025-12-18: Introduced in Senate

Bill Versions

Closing the Contraception Coverage Gap Act — issued 2025-12-18 — PDF (12 pages)