Equally Insured? What You Need to Know About Women and Health Insurance Coverage

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Access to affordable and comprehensive healthcare for women has been a major political issue over the past few years, especially as debates on the government’s role in health care and proposed funding cuts have reached a fever pitch. These debates shouldn’t come as a surprise: one in five of the women in the U.S. between the ages of 18 and 64 are uninsured, making concerns about where women can access health care a serious and urgent issue. Women are at higher risk of being uninsured or underinsured because they are more likely to be covered as dependents through working spouse’s employer-sponsored plans, are less likely to meet Medicaid qualifications, and may have more health concerns that result in pre-existing conditions.

Yet insurance concerns for women go far beyond the uninsured. Even women who do have insurance may face uncertainty in coverage, higher prices, greater out-of-pocket costs, and even outright discrimination based on gender alone. Even worse, many women may not even realize the risks, both to their health and financial well-being, that the current state of the insurance market places on women.

While current legislation may help to remedy many of these issues (including the Affordable Care Act), it doesn’t eliminate the need for women to cultivate an in-depth understanding of their insurance, including what it covers, how much it costs, and the legislative factors that can influence a woman’s ability to be approved for coverage at all. Here we’ll address some of those basics and provide a solid list of resources for women interested in learning more about where they can turn for help in finding fair and secure coverage for their healthcare needs.

Why and How Coverage for Women Differs

While women have gained greater equality in nearly all aspects of everyday life over the past five decades or so, insurance coverage is one area where discriminatory practices based on gender are still allowed. As surprising as it might be, men and women aren’t treated equally when it comes to pricing, risk assessment, and the comprehensiveness of their care. There are some reasons why, though they often don’t explain the extreme disparities in price between coverage for men and women.

Insurers justify charging higher prices for women because they assert (and research supports) that women’s healthcare issues are often much more complex than men’s. Women have the potential for pregnancy and all of the medical issues that may come with it, including high-risk pregnancy complications and postpartum care. Women also have higher incidence of chronic illnesses that require ongoing medical treatment (38% of women versus 30% of men), and are at greater risk of developing a wide range of chronic conditions, from osteoporosis to lupus to rheumatoid arthritis. When combined with the fact that women are more likely than men to seek out care for health-related issues and generally live longer than men, insurance companies see dollar signs when it comes to covering women.

Prior to the passage of the ACA, the wild fluctuations seen in the private insurance market reflected enormous disparities between premiums charged to men versus women. Depending on the source of a woman’s health plan, that may have translated into substantially higher rates in many parts of the country, even when applicants were healthier than their male counterparts. For example, a survey of available private insurance offerings in 2008 showed that in the capital cities of all 50 states, more than 60% of insurance plans charged a 40-year-old non-smoking woman higher premiums than a 40-year-old man who smoked. Women covered under employer-sponsored health plans, even as dependents, fare better; premium rates are only slightly higher than the rates for men.

Private insurance rates varied by city and state, but while some saw only a 1% surcharge tacked on for their gender, others saw rates shoot up as much as 63% for the same coverage. Until the passage of the ACA, this sort of gender-based pricing was practiced by all the best-selling plans in all states, even when major areas of coverage that apply to women only, like maternity care, were excluded. That means in most places and in most cases, women are paying more, sometimes significantly more, than men for their coverage. That’s a big deal and a major contributor to some of the latest policies reforming the health insurance industry.

Policies That Affect Health Care Rates and Coverage for Women

Luckily, many of the practices that allow insurance companies to charge women higher rates than men are disallowed by the Affordable Care Act. While there are some existing state-based laws that help protect women against gender discrimination with regard to health insurance coverage, no legislation thus far has done quite so much to even the playing field in this respect. While some of these changes have already gone into effect, the biggest reforms are happening now. Any woman electing health insurance from an employer, a private insurer, or from the ACA’s health care exchanges can expect the following changes to take effect on Jan. 1, 2014.

Here are some of the major ways the ACA will shape women’s healthcare and insurance coverage.

Insurance companies will have to charge the same rates for coverage, regardless of gender or pre-existing conditions.

A big bonus for women is that they will no longer be charged a premium simply for being female, or for any other pre-existing condition (yes, prior to the ACA rollouts in 2014, being female is considered a pre-existing condition). This will prohibit insurers from charging higher rates or being denied covered for things like previously having had breast cancer, a Caesarean section, or having been the victim of domestic violence or sexual assault. The ACA currently prohibits gender-biased pricing in individual and small group plans. While large group plans are not required to offer competitive pricing for women, the ones that don’t are exempted from substantial federal tax credits, subsidies, contracts and other incentives; financially, it is in most large group plans’ best interest to offer identical pricing to men and women.

Coverage for birth control is mandated in most cases.

Half of the pregnancies in the U.S. each year are unplanned. Part of this may have to do with reduced or impeded access to birth control. Under the ACA, that will change, with all insurance plans being required to cover contraceptives completely (most brands of birth control are now available free of charge). Birth control is now considered an essential health benefit that all insurance plans must provide. There are exceptions, however. Some religious employers have been exempted from contraceptive coverage and plans through these organizations do not have to cover birth control. In early 2013, a new plan was proposed that offers women free birth control coverage through a separate plan if an employer objects to paying for contraception, which could help bridge the gap and provide access to birth control for all. Check your state’s policies for birth control and reproductive health coverage.

Plans must provide coverage for breastfeeding support, mammograms, cervical cancer screening and all other preventive care services.

This means that women will have access to pap smears, pelvic exams, and screenings for gestational diabetes, osteoporosis and colon cancer. Breastfeeding support can include breast pumps, supplies and counseling, and women will also have mandated access to services like HPV and HIV testing and counseling. Additionally, infants will be given all necessary vaccinations required by state school districts. Perhaps the best part of this legislation is that these services are entirely free to all women; private insurance may not require co-pays, and cost-sharing for these services is waived by Medicaid.

Medicaid will expand to cover more low-income women in some states.

While the Supreme Court blocked enforcing this change in all states, not all have opted out. In many states, the new regulations will make it easier to get Medicaid coverage, which can help struggling women get access to preventive and prenatal care. Under the new ACA regulations, women making less than $15,000 a year or families of four making $31,809 or less will qualify. Additionally, the law also changes some of the requirements of Medicaid so that even women who have no children and who are not pregnant may qualify. Check your state’s individual response to this legislation carefully.

State-based insurance exchanges must provide coverage for maternity care, both outpatient and inpatient surgical procedures, prescription drugs, rehabilitation services, and mental health.

For those who purchase insurance through the new health care exchanges, these programs are required to cover a wide range of essential services critical to women’s health. Everything from maternity care (commonly an expensive rider to older insurance plans) to domestic violence screenings is now covered, allowing many women greater access to these services.

Insurance will become more affordable.

Both women and men will get a break on insurance prices under the ACA. Starting in 2014, families and small businesses can receive tax credits on a sliding scale to help make insurance more affordable. The credits apply to individuals making less than $43,000 and will vary depending on family size (for example, a family of four making less than $92,200 will qualify).

There are other benefits, too.

These include being able to see an OB-GYN without a referral, guaranteed breaks and private space for nursing moms to pump breast milk at work, and home-visit programs for at-risk new moms. Young women will also be able to stay on family plans until age 26. Chronic illness sufferers no longer need worry about annual or lifetime coverage caps, as these are no longer legal.

Take Advantage of Your Benefit Reforms

While current legislation goes a long way towards helping women gain greater access to health insurance and the costs associated with coverage, it doesn’t mean women won’t still run into roadblocks to full health insurance coverage. Women are less likely than men to be covered through their employers – only 34% of women in the U.S. receive employer-sponsored insurance, compared to 45% of men. This means that the remaining 66% of women must either bear the entire cost of insurance themselves, or be dependent on a spouse’s insurance plan. The latter of these is a common choice for women (22% are insured as a dependent), especially for those who’ve decided to stay home and care for children.

While a smart choice for some, it isn’t without its risks. Should a relationship end in divorce or death, insurance coverage will be lost, potentially leaving women and children without adequate access to the preventative and clinical services they need. In fact, it’s estimated that as many as 115,000 women nationwide lose their health insurance each year through divorce, more than half of whom end up uninsured for the long term.

While women don’t need to rush out and get their own plans if they’re currently under a spouse’s, it is smart to have a plan in action should something unfortunate, like a divorce or the death of a spouse, leave them without coverage. Single women and women who already have insurance through their own plans aren’t exempt from this kind of planning either, as employers can drop plans and jobs can be lost. With premiums for individuals running an average of $5,615 a year for individuals and $15,745 for families, emergency options shouldn’t be ignored by anyone, and it’s wise to think ahead. If any of these apply to you, you’ll want to start planning how to meet your coverage needs now:

I’ve lost health insurance coverage.

Whether you’re insured by your employer or your spouse’s employer, educate yourself about your options should you suddenly find yourself uninsured. Besides the worry associated with the end of a marriage or loss of a job in the family, this additional stress can cause health problems you may not anticipate. Investigate options provided by your employer, such as through COBRA, designed to help you deal with the transition. Explore the options on your state’s healthcare exchange, and prepare yourself for the expenses involved in purchasing a policy for yourself and your children, if applicable. As you evaluate policies, remember that cost-sharing methods such as co-pays and deductibles play a major part in your out-of-pocket expenses, so weigh these factors as well as the monthly premium when making your decision. Lastly, investigate the federal and state benefit programs for which you may be eligible.

I don’t know what coverage I need.  

  • Fortunately, the ACA marketplace exchanges are designed to help you easily compare insurance plans side-by-side. As part of this groundbreaking healthcare reform, a number of essential benefits have been identified; all insurers are either required or incentivized to offer each of these benefits in a comprehensive plan. These essential services include: Emergency services
    • Hospitalization
    • Maternity and newborn care
    • Mental health and substance use services, including behavioral health treatment
    • Prescription drugs
    • Rehabilitative and habilitative services and devices
    • Laboratory services
    • Preventive and wellness services
    • Chronic disease management
    • Pediatric services, including oral and vision care
  • Knowing that these services are required in most plans may reassure you that you’re selecting the best coverage for you and your family. If you’re considering a large group plan that isn’t required by law to provide these essential benefits, check closely whether the plan does anyway; federal tax credits and funding have been built into the law to make this option very attractive to large group plans. While pregnancy and its associated costs are covered, do consider the possibility of fertility difficulties. The ACA does not mandate infertility coverage, though it does state that infertility is no longer a pre-existing condition and also offers tax credits to families struggling to conceive. Right now fifteen states mandate that health plans pay for fertility treatments.

I want to know my options.

Don’t be afraid to shop around. Investigate all your options for coverage, via your state healthcare exchange, an employer or spouse’s employer, and the private insurance market. The ACA’s flagship website offers a comprehensive assessment tool that can help you understand the finer details.

Additional Health Resources

While finding health insurance that’s both affordable and meets your meets is a challenging and perhaps even daunting task, there are plenty of resources out there available to help you do it.

For the Uninsured

Those without insurance don’t have to forgo medical care. While the ACA makes it easier than ever to get access to preventative care and other must-haves for women, there are other government agencies that can help as well.

  • The National Breast and Cervical Cancer Early Detection ProgramThis program offers free or low-cost mammograms and pap tests for women over 39.
  • Maternal and Child Health BureauIf you’re under 22 and have a child, you can get health care for both you and your family through programs offered under the HRSA.
  • Women, Infants, and ChildrenWIC provides education on nutrition and child care for low-income, breastfeeding, and postpartum women.
  • MedicareMore than 12% of women in the U.S. rely on Medicare to assist with their health care expenses. If you’re a woman making less than the minimum salary, you may qualify. Visit the program’s website to find out more.
  • Other resources: If you do not qualify for these programs, you can go to free clinics, get prescription drug assistance, or take advantage of nonprofit help. Do not neglect your health because you can’t afford insurance; there are resources to help you.

Educational Materials

Regardless of your insurance status, these resources can help explain the health insurance needs of women and ensure that you find the right coverage and programs to get you the preventative care you need.

  • Women’s National Law Center Health Care Reform Fact SheetsYou can learn more about the ACA as well as a large number of other women’s health issues through this organization fighting to improve women’s health in the U.S.
  • Women’s Health.govThis government site is a comprehensive source of information for those looking to learn more about women’s health issues. There are links to numerous organizations, programs, and resources to help you understand and find health insurance as well. Make sure to check out the Health Insurance and Women Fact Sheet.
  • HIPAAThe Health Insurance and Portability Act can help you to maintain your health insurance coverage after losing a job.Learn more about it here.
  • COBRACOBRA is another policy that can extend your health coverage after job loss.
  • Women and the Affordable Care ActLearn more about how the ACA will impact your health care options as a woman from HealthCare.gov.
  • The Health Care Law & YouHere, HealthCare.gov explains the impact of ACA and offers tools to help you make informed choices about your health.
  • Women’s Health Care PolicyThe Kaiser Family Foundation maintains a collection of fact sheets and studies that address policies that affect women’s health care. Also make sure to take a look at the foundation’s profile on women’s health care, complete with lots of interesting stats.
  • USA.gov Health InsuranceThis government site explains your health coverage options.
  • Choosing Health InsuranceConsumer Reports explains how to choose a health insurance plan, whether on your own or through an employer.

The passage of the Affordable Care Act is arguably one of the most women-centric pieces of legislation in U.S. history. The old days of relying on limited offerings from employers, choosing plans from the private market that were so expensive that women often skipped seeing the doctor, and opting to forego health insurance entirely are over. Comprehensive plans that meet all women’s medical needs are now required by law, and in many cases are much more affordable and approachable than ever before.

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