The National Women's Law Center says the health care law known as Obamacare will be good for women, providing them access to crucial preventive services. The group outlines the benefits here.
What kind of preventive women's services will be covered under health reform?
The Affordable Care Act requires new health plans to cover certain preventive services without cost-sharing, which means no additional out-of-pocket expenses such as co-payments, deductibles or co-insurance. Many of the preventive services that are covered in all new health plans are particularly important to women. These include, but are not limited to: well woman visits; contraceptive methods and counseling; breast feeding support, supplies and counseling; screening and counseling for interpersonal and domestic violence; mammograms for women over 40; cervical cancer screening; smoking and alcohol cessation programs; prenatal screening and tests; diabetes screening and counseling; blood pressure screening and counseling; depression screening for adolescents and adults.
All insurance plans sold in state exchanges or marketplaces must cover these preventive services.
How will reform make breast feeding more accessible to women?
All new health insurance plans are required to cover breast feeding support, supplies and counseling. This means more women will have insurance coverage for the purchase or rental of lactation equipment, such as breast pumps, along with lactation counseling. Coverage of equipment and counseling extends for the duration of breast feeding.
Also, the ACA requires certain employers to provide breast feeding women with "reasonable break time" to pump for up to 1 year after their child's birth. An employer with fewer than 50 employees does not have to comply if they show that the break requirements pose an undue hardship on the employer.
These employers must provide a space "that is shielded from view and free from intrusion from coworkers and the public" and the space cannot be a bathroom. Together, these new requirements represent a huge step toward reducing barriers to breast feeding.
What health plans don't have to offer these preventive services?
All "new" health plans are required to cover these preventive health services without cost-sharing. Health plans that existed before March 23, 2010, the date the ACA was enacted, are considered "grandfathered." Grandfathered plans are not required to cover these preventive services. Once a plan makes significant changes, such as changing covered benefits or cost-sharing or several other factors, it loses its "grandfathered" status and becomes "un-grandfathered." Un-grandfathered plans are group health plans created after March 23, 2010, group health plans that have implemented significant benefit or plan design changes, or individual plans purchased after that date. All un-grandfathered private health plans must cover preventive health services without cost-sharing.
According to the Kaiser Family Foundation, two-thirds of employer-based plans are un-grandfathered and are required to provide coverage of preventive services at no cost-sharing. A 2010 survey by then-Hewitt Associates found that 90 percent of all large U.S. companies expect that their health plans will lose grandfathered status by 2014. Eventually all plans will lose their grandfathered status and distinctions between the two types of plans will disappear. At that point, all plans will cover these important preventive health services without cost-sharing.
Existing Medicaid plans also are not required to cover these services without co-payments, however the ACA provides a financial incentive for states to do so. Many states already cover a wide range of preventive services for Medicaid enrollees with nominal or no co-payments.
What can a patient do if their plan doesn't cover these services?
There are several steps a patient can take if she has been charged cost-sharing, such as a co-payment or a deductible, for one of the preventive services. First, she should confirm that her health plan is un-grandfathered and must cover the services without cost-sharing. The health plan should be able to provide this information over the phone. The National Women's Law Center has an online guide that can help patients call their insurance company to find out if it is un-grandfathered.
If the plan is un-grandfathered and the patient is getting the preventive service from an in-network provider, the preventive service should be covered without cost-sharing. If the plan has inappropriately charged cost-sharing for the preventive service, the patient can appeal the charges. The National Women's Law Center has an online tool kit that can help patients appeal inappropriate cost-sharing, as well as a hotline to assist individuals dealing with this problem (1-866-PILL4US or firstname.lastname@example.org).
The Baltimore Sun has occasionally run questions and answers on implementation of the Affordable Care Act. See previous questions at baltimoresun.com/healthreform.