When I moved from Colorado back to California in 2005, I was denied health insurance because I was pregnant with my younger daughter. My husband and I were eventually able to get coverage under his employer’s group plan, but it was not the coverage that I wanted. It was frustrating and stressful. Then last year, I was denied coverage again because I’d sought treatment for Postpartum Depression after the birth of my daughter 8 years previous. My husband eventually accepted a job he wasn’t particularly thrilled about in order to ensure I’d continue to have health coverage. I have personal experience with the frustrations of seeking health insurance as a woman. So when Mike Cahill from Vista Health Solutions Blog offered to write a guest post about the Affordable Care Act and it’s relevance to women’s health care access, I was happy to take him up on it.
By Mike Cahill
If anyone could benefit from some changes to the healthcare system, it’s women. Women face a unique set of issues when it comes to health insurance. They are consistently charged higher health insurance premiums than men, and conditions like breast cancer, and even pregnancy, can be used as reasons to deny them health insurance. There is no debate that this is not just, and thankfully the Affordable Care Act (ACA) is making some changes that will brighten the picture for women purchasing insurance. Read on to learn a bit more about these changes.
Essential Health Benefits Cover Essential Services
The ACA mandates that every health insurance plan provide 10 categories of 'essential health benefits', making it so that all plans provide a minimum level of coverage no matter the cost. These categories of benefits cover a wide breadth of medical services. Some of these categories, such as maternity care and newborn care, are especially relevant to current or expecting mothers. If you are interested in the full list of essential health benefits, visit Healthcare.gov.
The preventative services category is especially helpful to women. Annual well-woman visits and routine mammograms will be covered with zero out of pocket costs. This page at HRSA.gov has a full list of women’s preventative services covered under this category.
While the ACA mandates the 10 categories under which every plan must provide essential health benefits, it doesn’t outline specific medical services within those categories. Each state is creating a benchmark plan that every future health insurance plan in that state will have to match to meet minimum medical benefit requirements. The Kaiser Family Foundation has a list here of each state’s benchmark plan.
Buying As An Individual? Don’t Worry About Gender Rating
The ACA has ended gender rating for women buying health insurance as an individual. So, if you are a freelancing or self-employed woman looking for insurance, you should expect to be charged the same premium as a man. This small change can make a big difference when it comes to paying your premium.
A Solution To Denial Based On Preexisting Conditions
Chances are you have heard about how the ACA protects people with preexisting conditions. This has special bearing on women. Women with breast cancer will no longer be denied insurance because of this terrible and costly condition.
In the past, women could be denied coverage for being pregnant. Since the ACA looks at it as a preexisting condition, pregnant women can rest easy knowing they can purchase coverage.
An Overall Improvement
While some may have their criticisms of the ACA, the law is benefiting women in a number of areas when it comes to getting health insurance. Use this information and take a look at the marketplace. Knowing the changes the ACA mandates, the available plans might start to look like a better deal than they did before.
Michael Cahill is the Editor of the Vista Health Solutions Blog. He writes about the health
care system, health insurance industry and the Affordable Care Act. Follow him on Twitter at @VistaHealthMike
Pingback: Why I’ve Been A Bad Blogger & Some Recommended Reading |
My family always had these coverages through my husband’s work but now we must pay $300 more per month and they cover less. Last check up I was weighed, had my blood pressure taken and had an exam. My insurance covers no blood work for yearly check-ups anymore and only a few vaccinations for the kids when they are under 6. They cover all kinds of exotic sexual prevention services but dropped most of the ordinary stuff. They no longer cover chiropractic and our deductable is $3,000 before they pay anything. It is not like we are so wealthy that this isn’t a problem. We only make $50,000 for a family of four. I think the only people who have improved care are the very sick and the very poor. The average person and especially the self-employed that I know, have been hit hard by increased costs and decreased coverage. I would gladly trade our insurance for the British/Canadian model or the old cheap high deductible catastrophic policy but the current situation stinks.
My experience has been different, I have a very reasonably priced plan that provides very good coverage available to me.
All though I myself am disgusted by the current health care changes, just as much as I was the health care system before the changes, you deserve kudos simply for expressing an opinion considering how volatile the subject is.
Myself, as a married woman who is incapable of having children after surgery, I am rendered at a loss by the assumption that I should be glad to see other women receive subsidization in this manner. Women have higher premiums because they have higher health care costs.
If you chose to have children, then you can choose health insurance to cover the pregnancy. Rendered sterile, there is no reason for my husband and I to pay the additional coverage for pregnancy related conditions. This has certainly not lowered costs for us, and instead would have increased them substantially… so we’ve had to cancel our insurance. For at least the first few years it will be cheaper to pay the fee and take our chances then the all encompassing insurance requirements now in place.
The “death” of the middle class in America is a common theme. As a staff accountant I work each year with dozens of families and business’s and I think I can at least add my two cents. The middle class has begun to dwindle because we attempt to legislate it as a bare minimum. Instead of being able to purchase catastrophic coverage, we are now forced to no coverage… because the government would like to legislate a bare minimum. This concept plays out in many directions. Another example is housing; houses have a minimum square footage for new builds which means that purchasing a small house and building on in 10 years is no longer possible. You must be able to purchase a medium sized home or no home at all. By doing this it removes the lower rungs of the ladder. You can either live in absolute poverty, or middle class. There is no place financially to transition.
Finally, if the USA, as a country, wants to provide a more affordable health care solution, the word “insurance” should not be part of it. Insurance is a specific type of savings plan in which people with higher risk pay in at a higher rate and are subsidized by the many who pay a much lower premium but never access the funds. When the government attempts to legislate “insurance” based on the idea that the higher risk prices will be absorbed by everyone and that everyone will take the value of their payments back in the form of healthcare, it is not only a lie, it is a fiscal impossibility. I flinch whenever I hear someone who should understand finance, refer to the new legislation as insurance.
As a “fiscal conservative” I can tell you that socialism doesn’t scare me and may be warranted here… but that is a whole different conversation.
Oh, and I very much enjoy your blog.
Move to Canada..maybe the weather isn’t Cali but dear God, you wouldn’t be in this predicament. Yes, we pay high taxes and maybe you guys think we are a bit too socialist for your liking but nobody is denied healthcare. All that crap about the waits in ER is just that. Had a visit there recently (one of the busiest ER’s in the country) was seen and had a CT within an hour and a half, then seen by surgical residents and house surgeon and sent on my way, after an IV of antibiotics, with a follow up appointment. Ok so maybe our hospitals are not necessarily the Ritz but we offer some of the best health care in the world. I work in one of the top cardiac centres in the world and wouldn’t go anywhere else for cardiac care.
No it’s not ‘free’, as I mentioned, we pay pretty high taxes. Our (working) twenty year olds and pensioners alike contribute so the system will be there for them when they need it. Right now, in our Province of Ontario the flu shot is free of charge to all. Someone joked that if you stand still you’ll have a needle jabbed in your arm. But it reduces hospital admissions for the flu and that saves a lot of money as well as many lives.
I am so sorry that you were denied care for post partum depression and that your spouse has to take a job, not to his liking, to get health care. That is really terrible. The United States has many wonderful things to offer it’s citizens, how sad that health care isn’t one of them.
Under the ACA I now have access to affordable and excellent health care! So it’s getting better, tho it’s not perfect.
The mythology I hear about how Canadians hate their health care system always makes me laugh, because I have quite a few Canadian friends and they are very appreciative of their system.
Yup! And same for people who live in Australia, New Zealand, Sweden, Finland. . . etc. They all love having national health care. Yeah, there are kinks in the system and some things that are difficult, but it’s no different than the insurance system, really.
49-State Analysis: Obamacare To Increase Individual-Market Premiums By Average Of 41%
The lower premiums are typically a result of government or employer subsidizing. To me, it’s not an issue of what is being offered; it’s that the plan, as written, is not fiscally sustainable.
I’m interested in seeing how this all plays out over the next few years. There certainly is a great deal of speculation on both sides, and it’s clear than a lot of people are very worried. Things rarely turn out exactly as we expect them to though, I’m optimistic that we’ll be able to work together as a society to create something better than what we’ve had.
Sure, premiums MAY be lower for some people, that’s because the cost is subsidized by everyone else – forcing a single 20-year-old single male or a 70-year-old single female for maternity care in order to subsidize someone else.
As another commenter mentioned, artificially low premiums are only part of the story:
Cherry-picking a couple of “benefits” can’t cover up for the complete boondoggle that the “Unaffordable Care Act” actually is. Is our current healthcare system ridiculous? Heck yes. Is ObamaCare the fix? Heck no.
Thanks for the links!
However, because of ridiculously high premiums and ridiculously high deductibles, you’re still going to be on the hook for huge medical bills! Plus, even when you’re healthy and don’t need it, there is going to be a massive drain on your bank account every month. Personally, I think I’m a much better investor than the government, I’d rather manage my own money and health, thank you very much.
The plans I’ve seen have all been very reasonable, can you link me to some information on these high deductibles?
Same. I’ve found so many very reasonably priced programs for my family — out on the private market outside of the exchange.
Aetna is offering our family of 3 an 80/20, $5k family deductible (which isn’t very high if you ask me), for $335/mo. This is less than my husband paid for an 80/20, 15k family deductible through his work. He paid $320/mo, and the company matched that $320, apparently, meaning that the total payment per month was $640 for a worse plan.
As we want to move up to a higher deductible plan when we have over $15k saved up, I looked at Aetna’s plans for our family of 3 for the 80/20 with $15k, and then the payment would drop to $190/mo. I figure that at $2280/yr, that’s definitely affordable.
And, you know, this included a great dental rider, plus a disability/dismemberment rider, plus also a catastrophic illness rider. It wasn’t the cheapest, worst plan. It was a decent PPO with a simple copay (preventative care was free; extra appointments were $10 copays; specialized testing was $50 copays; and prescriptions were $20 copay).
Honestly, it’s better insurance for a lot less money than we were paying before, and as such, when my husband negotiated his pay at his new gig, he asked for $5k signing bonus to put towards the deductible investment, and he simply padded his asking price by $2500 to cover the cost of buying the insurance ourselves.
So in all honesty, I’ve only find good plans. I don’t really get what people are that upset about.
Actually, most premiums are lower than initially projected:
Also, there are some great subsidies that the ACA pumps into the individual marketplace to keep premiums low for individual purchasers.
Also, insurance companies must use 80% of premiums on patient outcomes. That means if they use more than 20% of your premium on anything like office supplies, bonuses for execs, etc., you’ll get a refund of the difference.
Sounds like you’ve gotten caught up in the misinformation loop. I’d suggest you check out some of the reporting Sarah Kliff has been doing, which is pretty nonpartisan in its approach to the ACA.
“even when you’re healthy and don’t need it.”
Oh, okay. So when YOU get in a car accident and are rushed to the emergency room with broken bones and get slapped with a $30,000 bill that you can’t pay, WE all need to cover it for you. Since you’re such a great “investor” of your health. Got it.
And for those who say, “I am infertile so I shouldn’t have to pay for maternity coverage or prenatal…”
I may never have a heart attack or diabetes or Parkinsons but I understand that the cost is spread out over all of our needs… I cover your pregnancy, you cover my *I’m having a hard time coming up with something here because (knock on wood) I am a childless healthy 50yo* … we all put in the pot and when that illness or accident or trauma happens we are covered.
Now, honestly, I think the mess could be completely cleaned up by eliminating the middle man (aka Insurance) all-together.
I watched my pregnant, unemployed (substitute teacher at the time) friend, who had sex ONLY ONCE with her boyfriend, get denied over and over because she was pregnant. Thankfully near the end she finally was able to get insurance before the baby was born, but it was awful. This poor girl had enough to worry about without the fear of huge medical bills hanging over her head. Well done Obama and ACA.
and I also am not saying there are not flaws to this program, of course there is, but in some respects it’s going to be a good system that benefits many.
Thanks to ACA there need never be another person who doesn’t get a symptom checked out due to fear of a diagnosis and the hopelessness of medical bankruptcy.