As of August 1, 2012, all new health insurance plans are required to offer a list of new women’s preventive care services for no out-of-pocket cost. This affects both group and individual markets, and has been a long battled-over law among religious affiliates and conservatives for many months, due to the nature of this being referred to as the Birth Control Mandate of the Affordable Care Act. However, despite the dispute, the law is now in place.
The new preventive care benefits made free of charge for insured women include:
- Breast and pelvic exams
- Well-woman visits, including Pap tests
- Prenatal care
- Breast-feeding supplies, support, counseling
- Human Immune-deficiency Virus screening and counseling
- Human Papillioma Virus (HPV) testing
- Sexually Transmitted Infection counseling
- Domestic violence screening and counseling
- Screenings for gestational diabetes
Any woman who is fortunate enough to be shopping for health insurance from this day onward will receive all of these benefits covered in full, as other preventive care benefits have been since the ACA’s introduction. Women who are already insured will be able to use these benefits upon renewing their plan. Prior to this law, health insurance policies were required to include only covered annual OB-GYN exam as a preventive benefit, and prenatal care has been scarcely offered for a discounted, in-network rate. There are companies that have accommodated pre and post natal or maternity care, including certain plans from Kaiser Permanente and Health Net. For the majority of health insurance carriers in the nation, maternity care has been a costly additional benefit if available for coverage at all.
With insufficient coverage for such crucial health services as ensuring a safe pregnancy, preventing disease, and screening for cancer, nearly 50% of the women in the nation delayed or disregarded the need for care due to the cost. Bringing these new, fully covered benefits into health insurance plans will likely increase the number of women using these necessary services instead of those allowing health problems to escalate.
Many of the services are not controversial, though the inclusion of birth control was enough to set aflame the Catholic Church, who was inspired enough to begin a series of law suits. Thankfully, common sense and equality took priority, and now women with health insurance through their employer or an individual plan can have access to these services for free.
New Services and New Plans
Already effective in non-grandfathered health insurance policies, purchased since the Affordable Care Act was created, are 14 other free preventive services for women. These services include mammograms for women over 40, and osteoporosis screenings for women over 60. The new additions vary in frequency, most being annual exams. Annual services include well-woman visits, sexually transmitted infection counseling, HIV testing, and interpersonal and domestic violence screening and counseling. High-risk HPV testing for women 30 years of age and older will occur once every three years for women with normal cytology results.
Contraceptive coverage applies to all FDA-approved methods of birth control, sterilization procedures, and patient education for all women with the ability to reproduce. Coverage for breastfeeding support, supplies, and counseling includes care from a trained health care professional during pregnancy and/or after delivery.
New Services and Old Plans
“Grandfathered” plans and the new health care reform laws may not be compatible, however. Health insurance plans purchased before the health care reform law was passed in March 2010 will not necessarily grant access to these types of care. Due to the status and laws surrounding such plans, new women’s preventive care may or may not be included. If the services are offered to women with an old plan (typically through employers), the patient may have to pay cost-sharing of some sort, though it has not yet been addressed.
As of 2011, a Kaiser Family Foundation survey revealed that 56% of insured employees are in plans with “grandfathered” status, though the poll included both men and women. Health care policy experts project these plans will dwindle in number over time as alterations occur, ultimately leaving behind the “grandfathered” plan. If you are a woman with group insurance coverage, it would be in your best interest to clarify which type of plan you have in order to find out whether these benefits can work for you.