Most doctors and patients do not understand the implications of the Affordable Care Act. The American College of OB-Gyn provided some information that is very useful.
Did you know that 20% of women between the ages of 18-64 in the U.S. do not have health insurance? The ACA will require nearly all Americans to carry health insurance or pay a fine. The ACA will give the states the option of expanding Medicaid to cover low income women, even if they are not pregnant.
Health plans provided through the ACA have certain minimums. All plans are required to cover pregnancy and delivery. Insurance companies cannot charge higher premiums for women than men. Women cannot be denied insurance due to pre-existing health conditions, including previous C-sections or domestic abuse.
Plans must include the following for women without cost sharing: well-women visits, FDA approved contraception and counseling, mammography and genetic testing for breast cancer, the HPV vaccine, and domestic violence screening and counseling.
Let’s look at the provided benefits.
There are ten essential health benefits included in the plans: office visits, ER services, hospitalization, maternity and newborn care, mental health and substance abuse treatment, prescription drugs, rehab services and devices, laboratory services, preventive, wellness services and chronic disease management, and pediatric services that include dental and vision care.
Services that are included in the plans that are free include: well woman visits, FDA-approved contraception methods and counseling, screening for gestational diabetes, mammograms, PAP smears, STD testing and counseling, breastfeeding support and supplies, and domestic violence screening and counseling.
Services that are included with cost sharing include: anemia screening for pregnant women, urinary tract infection screening, BRCA counseling, breast cancer chemoprevention counseling for women at high risk for breast cancer, cervical cancer screening visits for sexually active women, folic acid supplements for women planning to become pregnant, osteoporosis screening for women over 60 dependent on risk factors, RH screening for pregnant women, and tobacco use screening and interventions.
Six insurance reforms were included in the ACA. They include: no exclusions for pre-existing conditions, no gender rating differences, no nine month waiting periods, no annual lifetime limits, no rescissions except for fraud, and the 80-20 rule. This rule mandates that insurance companies must spend 80% of premium dollars on your health care and quality improvement, leaving 20% for administrative costs and profit. The remainder of the 80% not spent on health care must be returned to the insured.
The ACA includes four plan tiers in the marketplace. The differences depend on the percentage of the health care cost that the insured vs. the insurer will pay. Bronze plans 40% insured-60 % insurance, Silver plans are 30-70, Gold are 20-80, and Platinum 10-90. All plans must include the 10 essential health benefits, the 17 preventive services, and abide by the 6 insurance protections that are described above.
The deadline for open season participation ends March 31. There are 18.6 million women who do not have health insurance now and are eligible for this coverage, and another 4.6 million low income women who could benefit form Medicaid expansion.
Although we might debate the costs and implementation of the ACA, it is obvious that the plans offer many benefits for women, often excluded in previous health insurance plans. So often, women are denied health insurance for one abnormal test result many years ago, or for a health condition that has been resolved. All in all, the ACA is good for women.