“Women utilize more medical services than men due in part to longer life expectancies, the need for reproductive care and a greater likelihood of chronic disease and disability,” analysts noted in a February 2013 report for The Kaiser Family Foundation. “Furthermore, women take major responsibility for coordinating care for family members, shoulder higher annual health care expenses, face more affordability challenges and are more likely to experience inconsistent insurance coverage compared to men.”
Thanks to the 2010 Affordable Care Act, also known as Obamacare, certain important preventative measures are now covered without a copayment, including annual “well-woman” checkups, HPV testing, screening for gestational diabetes, mammograms, breast-feeding support and services, screening and counseling for domestic violence, and some types of Food and Drug Administration-approved contraceptives. Insurance agencies are no longer allowed to charge women higher premiums than men, something that had been a barrier to women trying to find affordable coverage.
If you don’t already have health insurance through your employer, the new health care law’s individual mandate requires you purchase it. To make doing so a little easier, state-run health care marketplaces and the federal exchange will offer plans to consumers in 2015, from Nov. 15, 2014, to Feb. 15, 2015,
giving consumers a variety of choices. Last year, an estimated 18.6 million uninsured women were eligible to buy health insurance in these marketplaces, according to the Department of Health and Human Services.
“The most important thing for uninsured women to consider is simply completing an application for the health insurance marketplace,” says Nancy C. Lee, HHS deputy assistant secretary for health and director of the Office on Women’s Health.
“The application is free to fill out, and there’s no commitment once it is completed,” she points out. “Women who need affordable health insurance have nothing to lose by filling out an application.”
Experts advise women to keep these things in mind when selecting a plan:
Financial help is available. Federal tax credits (to help pay for health insurance) will be available for households with incomes up to 400 percent of the federal poverty level. This year, that’s $45,960 for individuals or $94,200 for a family of four. Those with incomes up to 250 percent of the federal poverty level ($28,725 for individuals and $58,875 for a family of four) can get subsidies to help pay out-of-pocket expenses.
Of single-parent households led by women in 2013, 92 percent have incomes below 400 percent of the federal poverty level, according to the National Women’s Law Center. “Nearly 80 percent of all single-parent families are headed by women,” adds Judy Waxman, NWLC vice president of health and reproductive rights. According to HHS, women who earn less than 133 percent of the federal poverty level will be eligible for Medicaid coverage, even if they have no children and are not pregnant.
Different plans offer different levels of maternity coverage. Since the Affordable Care Act was fully implemented in 2014, all insurance plans are required to offer some maternity coverage. But insurers have wide latitude to determine which maternity services are offered above the basic legal requirements. The National Partnership for Women and Families cautions that pregnancy-related counseling, prenatal care, midwifery services, enhanced coverage for high-risk pregnancies, labor and delivery services outside of a hospital setting and neonatal care may not be included in every plan. Other women’s advocacy groups agree, and advise women to weigh their options carefully. “If a woman is planning or
hoping to get pregnant, she should look at what specific maternity services are covered under each plan and if there are limits,” says Rachel Fleischer, a spokesperson for Planned Parenthood Federation of America. “She should check out if there are limits, caps or specific requirements around services.”
For some women, having health insurance could be a matter of life or death. “An infant is six times more likely to die in infancy if the mother didn’t get prenatal care, and a woman is two to three times more likely to die during pregnancy or childbirth without prenatal care,” says Terry O’Neill, president of the National Organization for Women. “Obamacare is going to be lifesaving for many, many women.”
Mental health coverage may be available. “When choosing a plan, women should consider mental health coverage for their emotional well-being,” Fleischer says. “Coverage for things like marriage counseling and managing depression or anxiety could vary significantly.”
If you’re a parent, you need to consider coverage for your children. Children in low-income families may be eligible for Medicaid or the Children Health Insurance Program. Eligibility varies by state, but four-person families with incomes of less than $45,000 will qualify, although some states also cover families earning slightly more. Children with preexisting conditions cannot be denied coverage, and adult children ages 19 to 26 will be able to remain on their parents’ plans.
Under the ACA, most plans will offer 26 preventative services for children at no additional cost, including immunizations, behavioral assessments and certain screenings (a full list is here). Insurance policies must also cover children’s vision and dental services without cost-sharing.
You can’t be turned down if you have a preexisting condition. Even if it’s something as serious as breast cancer, you’ll still be able to buy insurance in the state-run marketplaces – regardless of whether you’ve been turned down by an insurer in the past.
“When your cellphone contract ends, you spend hours and hours researching other plans,” says Nicole Duritz, vice president for health education and outreach at AARP. “We encourage people to invest the same time and energy in their health care.”