Women’s health coverage
For women in the United States, access to affordable coverage in the individual health insurance market has improved significantly over the past decade, largely due to improvements in coverage and consumer protection provided by the Affordable Care Act.
Prior to the introduction of the ACA – mainly in 2014 – women faced many obstacles to coverage:
- Previously, more than half of individual plans charged higher premiums for a 40-year-old non-smoker than for a 40-year-old male smoker for exactly the same coverage.
- More than 90% of individual health plans do not provide any routine maternity benefits.
- In all but five states, pregnancy was a pre-existing condition that prevented women from purchasing individual health insurance.
- Many individual health plans do not offer contraceptive coverage.
- The scope of preventive care for women varies considerably from one country to another.
We hope you will use this guide to understand more clearly how coverage has improved – and what to expect for women’s health coverage when choosing a health plan.
Preventive care for women under the ACA
Prior to the implementation of the Affordable Care Act, the scope of preventive care for women varied considerably from country to country. But starting in August 2012, all health plans (except Grandpa’s health plans) had to provide coverage for certain categories of preventive care specific to women:
- Visits of a good woman
- Check for gestational diabetes
- HPV test
- Domestic violence screening and counseling
- HIV testing and counseling for sexually transmitted infections
- Breastfeeding supplies
- Consultations on contraception and family planning
(Note that additional mandates for preventive care, including preventive care for children and all adults, as well as additional preventive care specific to women, entered into force in 2014)
Coverage of women’s health services
Maternity care coverage
Prior to 2014, only 12% of individual market health plans included maternity benefits. But the Affordable Care Act changed the game. Maternity care is one of the main health benefits that should be included in all individual and small group policies.
This means that the prospective parent can now receive coverage in each state during an open enrollment or during a special enrollment period triggered by a qualifying event. And women are no longer charged higher premiums than men, despite the fact that every new major health policy includes maternity coverage.
Infertility treatment coverage
Infertility treatment is not one of the main benefits of the Affordable Care Act – and coverage for infertility treatment is not required by the ACA or other federal law. But some states have regulations that go beyond the minimum requirements set by the federal government with their own laws, regulations and mandates.
These state rules apply only to state-regulated plans, which include health plans that individuals and companies purchase from an insurance company. However, employer-sponsored self-insured health plans are not subject to state insurance rules.
Abortion coverage is neither mandatory nor prohibited under the ACA. But federal funds cannot be used to pay for an abortion unless the situation involves rape, incest or danger to the mother’s life. Coverage for other abortions varies greatly from one health plan to another.
The Affordable Care Act has improved access to highly effective, long-term contraceptives without a cost barrier. According to the ACA, health policies that came into force on or after August 1, 2012, must cover – without cost-sharing – at least one version of each FDA-approved contraceptive method for women. This includes sterilization, IUDs and implants, which often had significant initial costs before the ACA.
The latest news
Access to women’s health services has been significantly expanded under the ACA. This is due not only to the ACA coverage mandates (for things like preventive care and maternity care), but also to the fact that the ACA has led to many more women having health coverage. The expansion of Medicaid, the mandate of the employer and access to subsidized coverage on the health insurance market / market have played a role in this.
But women’s health coverage and care remain controversial issues, and the rules continue to evolve over time.