January 31, 2023

Filipino Guardian

Sentinels of Filipino Free Press

Women’s Health Insurance 101: ACA Coverage and Benefits

Each fall, when pumpkin spice flavors and trick-or-treaters make their annual releases, another seasonal milestone arrives: open enrollment in the state and federal health insurance marketplaces (Healthcare.gov). Between November 1st and January 15th, anyone can take out health insurance or switch tariffs.

Health insurance might not be as fun as other fall traditions, but making sure you have solid health insurance coverage can protect you financially when you need care.

Thanks to the Affordable Care Act (ACA), sometimes called Obamacare, health insurance can be key to women’s access to health care — but only if you get the right plan. Learn what women’s health benefits you are entitled to and how to get the best women’s health insurance coverage.

What Obamacare means for women’s health

The Affordable Care Act (ACA) sets new rules for health insurers. Before the ACA, health insurers could refuse coverage for pre-existing health conditions – something they can no longer do – and what you may not know is that pregnancy and surviving domestic violence are considered pre-existing conditions.

Another change that came with Obamacare is that health insurance companies can no longer charge women higher premiums than men. Before the Court of Auditors, women often had to pay 30% more than men.

The ACA also requires insurers to cover a set of 10 essential health benefits (EHBs), including some benefits specific to women’s health.

Affordable Care Act and Birth Control

Before the ACA, only one in three women with individual health plans were using birth control. Today, all plans sold on the Health Insurance Marketplace and most other private health plans cover patient education and counseling and FDA-approved birth control methods with no co-payments or co-insurance. In order to receive coverage, you must obtain a prescription from a health care provider (HCP) that participates in your health insurance plan.

Contraceptive options covered by insurance include:

Diaphragms and SpongesHormonal Birth Control Pills and Vaginal RingsIntrauterine Devices (IUDs)Emergency ContraceptionSterilization Procedures

It’s always a good idea to check whether your specific birth control method (e.g. a particular pill or device) is covered.

There are some exceptions. For example, drugs that induce abortions do not have to be covered, but certain health plans may choose to cover them.

Health plans funded by religious employers can request exceptions to these rules and choose not to reimburse contraceptives. If you work for a church or other religious organization that opposes birth control, you may have to pay for birth control out of your own pocket. However, you may still have coverage through a third party benefits administrator. Check with your health plan or employer for details of your specific coverage.

ACA Pregnancy, Maternity and Newborn Care

ACA-compliant insurance plans include coverage for prenatal care and childbirth, and post-delivery care for you and the baby. That was not always so. Before the ACA, most women with individual health insurance had no maternity coverage.

Prenatal care is a form of care that the ACA is required to cover by insurers without co-payments or other consumer costs (if you receive benefits from participating HCPs). Although insurers must cover these services, they are allowed to share the cost of the birth with the patient, so you may have co-payments or co-insurance for the birth.

Pregnancy may qualify you for free or low-cost Medicaid or Children’s Health Insurance Program (CHIP) coverage. Pregnancy may also allow you to enroll in Marketplace health plans outside of the open enrollment period. Pregnancy does not automatically trigger a special enrollment period, but pregnancy does. After the birth, you can take out health insurance for the first time or change it. You can also insure your baby and other household members.

life changes such as Events such as moving house or losing insurance coverage may trigger a special enrollment period in which you can sign up for health insurance whenever your situation changes.

ACA breastfeeding support

If you are breastfeeding, your ACA-compliant health plan must provide support and coverage for breastfeeding counseling/lactation services and equipment. In particular, health insurance companies must cover the cost of a breast pump — either one you rent or one you keep. Health plans can differ in what types of pumps they cover, how long you can have them, and whether you can get them before or after birth. Sometimes health insurers will only cover what your HCP deems medically necessary, and may require you to obtain prior approval — pre-approval — before covering those services and products. Talk to your HCP about their recommendations and how they can help you get covered benefits.

Other essential health benefits

Additional benefits that health insurance companies are required to cover under the Court of Auditors include many benefits that women need, including:

Preventive and wellness care, including preventative services for women such as mammograms and cervical cancer screenings, Out-of-hospital visits to HCPs, Hospitalizations, Emergency services, Mental health and substance use disorder services, Prescription medications, Rehabilitation services and devices that help those with injuries or disabilities, Laboratory services, Pediatric services

Get the women’s health care you’re entitled to

To ensure you receive these benefits, you must be enrolled in an ACA-compliant plan, e.g. B. With a qualified health insurance plan – an insurance plan that is certified by the health insurance market. These plans may be available on or off the marketplace. Avoid catastrophic or “thin” plans that don’t have to meet the same coverage rules.

If you buy your health insurance through an employer, that employer may not be subject to the same rules. Ask your employer or benefits administrator if the plans they offer are ACA compliant. If not, ask about the specific services you may need to make sure they are covered.

Just because something is covered doesn’t mean it’s free. You may still have to pay part of the costs, such as a co-payment or co-insurance. But the rules mean your health insurer can’t set annual or lifetime limits on paying EHBs to you, which was allowed before the Court of Auditors.

Certain Services may also require you to obtain permission, known as prior approval, before you receive them. Work with your health plan to understand the rules and with your HCP if you need help completing the required requests.

Health insurance can be a headache, but for women in particular, it can be a lifeline — and save money.

From your website articles

Related articles on the Internet