Recent changes to the healthcare delivery environment have made long-acting reversible contraception (LARC) more affordable than ever for providers and clients. As a result of the Affordable Care Act (ACA), all insured individuals have access to core preventive healthcare services – including all Food and Drug Administration-approved contraceptive methods, including LARC methods, and contraceptive counseling – without cost-sharing or co-pays. This means that insured women and teens can obtain contraception at no cost to them. While not all clients have gained health insurance coverage through these changes, the number of insured women and teens has increase substantially because of Medicaid expansions, subsidies for private coverage, and coverage mandates.
CAI’s LARC Modeling Tool resource is intended to support healthcare service providers to examine assumptions about the affordability of LARC methods. Specifically, it calculates whether the costs associated with the provision of LARC will be covered (break-even), whether a profit can be realized, or if losses are projected based on an agency’s current payer mix (i.e. the proportion of clients insured by each third-party payer) and the reimbursement rates paid by each third-party payer. Going through this analysis will support healthcare service providers in examining the “business case” for the provision of LARC on-site, a best practice for increasing access to this first-line strategy for reducing rates of unintended pregnancy. Information gleaned from this analysis also can support negotiations with third-party payers, specifically with those plans for which the costs of providing LARC are higher than reimbursement received.
Suggested citation: Jones EJ, Middleton D. Understanding the Net Cost of Proving LARC Services: A Modeling Tool [Online Tool].CAI. [date accessed]. Available from: <website>.