How to Get Birth Control and Emergency Contraception in Texas

KERA | By María Méndez | The Texas Tribune Published March 14, 2024 at 5:03 PM CDT

Editor’s note: This story has been updated throughout to reflect changes in policies and access.

Most abortions are illegal in Texas, but adults in Texas still have access to a range of birth control and reproductive health care services through most health insurance plans and government-funded programs.

Access and confidentiality vary based on the type of birth control, insurance and whether funding comes from the state or federal government. For the most part, minors have to get parental consent for prescribed birth control, but they can also access some over-the-counter contraception options, like condoms. Here’s a rundown of how you can access birth control, emergency contraception and other services.

Does health insurance cover birth control?

Under the Affordable Care Act, most health insurance plans must provide contraception options and family planning counseling at no out-of-pocket cost, according to the U.S. Department of Health and Human Services.

This includes FDA-approved options prescribed by a doctor such as birth control pills, vaginal rings, implants like IUDs, barrier methods, sterilization procedures and emergency contraception like Plan B and Ella. You can learn more about contraception methods here.

However, insurance providers may not cover all contraception options and brands, especially if they are newer.

“Overall, insurers needed to provide at least one method in a specific class of methods,” said Kari White, an associate professor of sociology and social work at the University of Texas at Austin and the lead investigator of the Texas Policy Evaluation Project, a research group that studies the impact of contraception and abortion policy in the state.

Insurance providers are not required to cover abortion-inducing medications or vasectomies for men.

Religious institutions like churches are exempt from the requirement to provide employees with insurance coverage for contraception and family planning counseling, but you may still be able to access free services if your insurance plan is sponsored or arranged by a religious nonprofit such as a hospital or higher education institution. Private companies in which five or fewer people own more than half of the company can also object to covering contraception if it conflicts with the owners’ religious beliefs under a 2014 Supreme Court ruling in favor of retailer Hobby Lobby.

Read more about general health insurance coverage guidelines from the U.S. Department of Health and Human Services here.

Most insurance plans are also required to cover preventive health services such as Pap tests, breast and cervical cancer screenings, prenatal care, testing for sexually transmitted infections and screening and counseling for interpersonal violence.

Where can I get birth control if I’m uninsured?

Texas has more uninsured people than any other state, and it’s one of eleven states that have opted to not expand Medicaid coverage for low-income people. More than half a million Texans in a coverage gap earn too much to qualify for Medicaid and too little to afford private health insurance.

If you can’t access insurance through an employer or the federal marketplace, you can get contraception and preventive services at government-funded clinics.

Clinics that receive funding through the federal Title X Family Planning Program offer contraception, breast and cervical cancer screenings and screening and treatment for sexually transmitted infections.

There are more than 150 Title X clinics across Texas, according to Every Body Texas, which oversees the federal grants in the state. The clinics are meant to help teens and people who can’t afford health care, are uninsured or may not have a government-issued identification, but White, of the Texas Policy Evaluation Project, said they are open to anyone.

Services for men and women are provided on a sliding scale, based on income, and may be free for people who fall under federal poverty guidelines. You can find Title X clinics on Every Body Texas’ website.

Texas also funds certain birth control methods and other preventive services for low-income women through two programs called Healthy Texas Women and the Family Planning Program.

Under the Healthy Texas Women program, people can access birth control pills and other forms of contraception for free. The program is open to women in Texas between the ages of 15 to 44 years old who are not pregnant, are U.S. citizens or qualified immigrants and meet low-income standards. A single person can earn only up to $2,313 per month to qualify. Women under 18 must apply through a parent or guardian.

The state’s Family Planning Program offers similar free or low-cost services. It is open to men and women in Texas who are 64 or younger and who earn an income of up to 250% of the federal poverty guidelines for their household’s size. This year, the maximum for a household of one person is $33,975.

Under both state-run programs, a person is granted services for a year unless their income or qualification status changes. The person can reapply for benefits if they still meet qualifications. The state programs do not provide emergency contraception.

Some clinics work with both Title X and state funding, so staff there can help you figure out under which program you may be covered, White said.

What if I’m an undocumented immigrant?

Immigrants without legal status can receive care at Title X clinics and may qualify for Texas’ Family Planning Program.

I’m younger than 18. Can I get birth control without parental consent?

Texas requires parental consent for minors to get prescription birth control, including implants and IUDs. Due to a 2022 court ruling in an ongoing lawsuit, this also now applies to Title X clinics in Texas. Minors can still access testing and treatment for sexually transmitted infections, pregnancy tests, condoms and counseling without parental consent at Title X clinics.

Minors on the federal Medicaid program can consent for themselves to get birth control at any clinic that accepts Medicaid. Medicaid may send an explanation of benefits or follow-up letter, which parents have a right to read, said Stephanie LeBleu, the Title X Project Director for Every Body Texas.

Texas is also one of just two states that does not cover birth control at all — with or without parental consent — on the state-run Children’s Health Insurance Program.

Over-the-counter emergency contraception, like Plan B, and condoms are also available without parental permission in stores and online.

What about Planned Parenthood and other providers?

Texas also bars people from using Medicaid to pay for services outside of abortion, like birth control, at clinics associated with abortion services, such as Planned Parenthood. This also applies to women covered under the Healthy Texas Women program, White said. Even though Planned Parenthood has stopped providing abortions in Texas, in compliance with state law, the state is still trying to shut down the clinics with a $1.8 billion lawsuit.

The restriction does not comply with federal Medicaid guidelines, White said, but Texas spent about a decade fighting to remove Planned Parenthood from any state-funded programs. By 2014, 82 family planning clinics in Texas had shuttered, and only a third were from Planned Parenthood.

People with commercial insurance can access birth control and other services through providers like Planned Parenthood if they are in their insurer’s network, White said. People can also opt to pay out of pocket and some providers may have philanthropic support to serve people who can’t afford to pay, she said.

Through the Planned Parenthood Direct mobile app, people can also order birth control and emergency contraception. But for those 17 and younger, it would require parental consent in Texas for minors, White said.

How can I get emergency contraception?

Plan B, which can prevent pregnancy after unprotected sex if taken within 72 hours, is available for anyone to buy over the counter. Pricing can range from about $17 to $50 without insurance, depending on the brand and pharmacy. It must be prescribed by a doctor for it to be covered by insurance. Emergency contraception, including Plan B, may also be available through places that receive Title X funding such as clinics and local public health departments. There are also groups throughout the state that provide free emergency contraception.

Ella, another emergency contraception pill that works up to five days after sex, requires a prescription, but it can also be prescribed and ordered online through an online pharmacy, according to the online resource Bedsider, which is informed by medical professionals. This option is also more effective than Plan B for people over 165 pounds.

What are the options for vasectomies and tubal ligation?

Permanent forms of birth control like vasectomies for men and tubal ligation for women, which is also known as getting one’s “tubes tied,” can be options at Title X and Texas’ Family Planning Program clinics, but may require specialists outside of a clinic and some providers may not take lower reimbursements from government programs, White said.

“So it can be difficult for health care providers to work with an outside agency like an ambulatory surgical center or hospital to pay for that procedure,” she said.

Some commercial insurers may cover only part of the cost for a vasectomy or require patients to first pay a deductible, White added.

Are there any other resources?

The nonprofit Jane’s Due Process has guides to teen access to birth control and runs a hotline that teens can call if they run into issues navigating clinics and providers. You can call or text 1-866-999-5263. The nonprofit also has a list of organizations that provide free emergency contraception in Texas.

Bedsider offers guides informed by medical professionals on birth control and other reproductive health topics.

NPR’s Life Kit podcast has episodes and online guides on finding the right birth control for you, how to know when you’re ready to have kids and on navigating reproductive health care after the reversal of Roe v. Wade.

This article was originally published by KERA News.