Women and Health Insurance: What You Should Know

Many women find themselves juggling a million different responsibilities: a job, their home, maybe kids, a partner, pets... The work never stops, and "rest" is a word foreign to the female dictionary. Unfortunately, health can fall by the wayside, too. 

Don't you think it's time to think about your health? What do your body and mind most need? How long has it been since your last mammogram? When was your last pap? Do you have all your vaccines? And your annual check up? And what about that back pain?

• Find out about your state's health insurance marketplace here

Healthcare plans from the markets established under the Affordable Care Act (ACA) allow you to have coverage at accessible prices, and depending upon your income level, also offer financial help to pay your premiums (what you pay per month for your coverage).

You have to pay attention to the Open Enrollment Period because it can change depending on where you live. This period usually runs from November 1 to December 15th., however it could be longer in states that run their own marketplaces.

You and your family can have, and deserve, the best care.

• Do you need help buying medical insurance? Call us at 866-295-1220 or provide us with your information here and we will contact you.

But what do these plans offer that others do not that may be especially attractive to women?

Below are answers to healthcare questions that you have likely asked yourself at some point. Read on to learn how to keep yourself healthy and strong, and what the health insurance marketplace can offer exclusively to women.

Are there preventative services specifically for women?

According to ACA requirements, marketplace plans must include a series of preventative services for women without cost-sharing. 

For example, this includes assessment and detection services; postpartum care; breast and cervical cancer detection; genetic assessment and tests for women with a high risk of breast cancer; chlamydia and gonorrhea detection and assessment for high-risk women with at least one check-up visit per year; birth control services and supply, including prescriptions of birth control approved by the FDA; breastfeeding support and counseling services, including breast pump rentals; and domestic violence testing and assessment. 

You should always check with your physician to see if there are any prior requirements that must be met. And one basic piece of advice: always make appointments with physicians that are in your healthcare plan's network of providers.

Do marketplace plans offer full coverage for birth control?

Yes, your plan should cover a wide variety of birth control methods approved by the Food and Drug Administration (FDA), but it may impose some restrictions on those offered at no cost. For example, the plan could require that you choose a provider within your network to give you the prescription and tell you that you must use generic birth control instead of a brand name, unless the brand name is necessary for medical reasons. 

 If the generic drug or device does not work for you, you can ask your doctor to ask for an exception from your healthcare plan to receive the brand-name drug or device without cost-sharing.

Do marketplace plans cover mammograms?

Yes, mammograms are considered preventative exams. The rule of coverage for mammograms is based on the Women's Preventive Services Initiative adopted by the Department of Health and Human Services (HHS), which recommends a mammogram every one to two years for women from 40 to 74 years old. 

If a woman has a family history of breast cancer, does marketplace healthcare cover testing to determine breast cancer risk?

There is a series of breast cancer detection tests and preventative services for women that insurers must cover. 

Insurance must pay the provider to assess whether or not the woman has a family history that would put her at greater risk of certain genetic mutations associated with a higher risk of breast cancer (BRCA1 and BRCA2). 

If the provider determines that her family history increases the risk of genetic mutation, the plan must cover the total cost of assessment and genetic testing if the doctor recommends it. If this woman turns out to have one of these genetic mutations, the insurer must also cover the total cost of certain preventative medications that could considerably reduce the risk of contracting breast or ovarian cancer.

What services do plans offer for pregnant women?

Federal law requires that all individual plans that follow Affordable Care Act (ACA) regulations cover services for maternity, childbirth, and newborn care. These plans must also cover prenatal visits and exams, folic acid supplements, smoking cessation counseling, and breastfeeding interventions and services without any copayments, as these are considered preventative services. All state Medicaid programs cover maternity care with no cost-sharing for low-income women who qualify for coverage.

Can looking for health insurance through Medicaid, CHIP, or the health insurance marketplace put undocumented families at risk?

Medicaid, CHIP, and the health insurance marketplace must protect people's information and keep it private. The information can only be used for eligibility and enrollment purposes. The information provided by applicants is not used for purposes of compliance with immigration laws.

Can immigrant women receive help with paying the premiums and/or shared costs of their health insurance?

Immigrants must be documented in order to obtain subsidies to help pay for the premiums and shared costs of health insurance bought on the marketplace. As is the case with citizens, they can obtain these subsidies, also known as tax credits, if their income is between 100% and 400% of the federal poverty line (between $12,000 and $48,000 annually for one person). They can also qualify for cost sharing reductions if they are between 100% and 250% of the federal poverty line. In order to receive this help, they should not have access to health insurance through work or be eligible for Medicaid.

Eligibility changes depending on the state.

Documented immigrants who earn less than 100% of the federal poverty line may also receive help paying premiums and shared costs if they cannot enroll in Medicaid due to their immigration status. Many immigrants with papers cannot enroll in Medicaid until they have been in the United States for five years or more.

Undocumented immigrants cannot receive help to pay premiums or shared costs, and cannot buy health insurance through the marketplace, even at full price. 

Sources: Kaiser Family Foundation, CMS, cuidadodesalud.gov