Starting Aug. 1 2012, new group and individual private insurance plans and non-grandfathered* renewing plans (plans purchased after March 2010) will cover eight new preventive services for women. These services will be added to fourteen women’s preventive services that have been covered since Sept. 2010. All services, in effect, will be free to women (no deductible or co-pay) with qualifying insurance plans.
Further, women have direct access to obstetrics and gynecological services without a referral from a primary care provider. New insurance policies will see the changes right away; others will see them when their policies renew—so it could be any time in the next year, depending on the insured’s policy renewal date.
Approximately 47 million women will be affected positively by these changes. But, the trick with preventive services is to get women to use them. If there is no up front cost, studies show, women are much more likely to use the services to get the care they need in order to stay healthy. Primarily because of cost, women put off necessary preventive care that will keep them healthy, avoid or delay the onset of disease, help them lead healthier, longer lives, and reduce health care costs.
Chronic diseases—responsible for 7 of 10 deaths among Americans each year–often are preventable. And yet if patients, especially women patients, have to pay up front for these services, they often simply go without. In short, women gamble with their health, and choose for the most part not to think about it . . . until something goes wrong.
Women are often the primary health care decision-makers for their families. They’re more likely discuss these essential decisions with friends. They are also the key consumers of health care. They have unique health care needs and have high rates of chronic disease, including diabetes, heart disease, and stroke.
If women are more in need of preventive services, they also are often less able to pay for these services. On average, they have lower incomes than men, and a greater share of their income is spent on out-of-pocket payments for health care. (For the first time, beginning in 2014, it will be illegal for insurance providers to charge women higher insurance premiums than men.) Moreover, when compared with U.S. men, women need more health care services, particularly during their childbearing years.
Yet, because women are more likely than men to be included on a spouse’s health plan, they’re more vulnerable to losing that insurance through divorce, death, or the elimination of dependent coverage. And, when women of childbearing age try to buy health insurance in the individual insurance market, they are charged higher premiums than men in most states and can rarely buy a plan that covers maternity care. American women pay an astounding $1 billion more every year on health insurance premiums than men because they go to the doctor more often.
A lack of comprehensive, affordable health insurance has exposed women in the United States to large financial risks during times of illness. In 2010, 18.7 million women between the ages of 19 and 64 were uninsured and an estimated 16.7 million had insurance that did not adequately cover them for necessary care. A recent study by The Commonwealth Fund found that a surprisingly high percentage of women in the U.S., both with and without health insurance, go without needed health care because of cost—and even a small co-pay seems to act as a deterrent.
In fact, over half of women without insurance (51 percent) said they had problems paying medical bills in 2009-2010, and 77 percent of these women reported going without needed care because of cost. But, it’s not just uninsured women who knowingly choose not to take care of their own health because of how much it costs. “43 percent of all women in the U.S. reported they went without recommended care, did not see a doctor when sick, or failed to fill prescriptions because of costs in the past year,” according to the Commonwealth study.
When the co-payment or deductible is removed, however, it significantly increases the likelihood that women will get the preventive services they need to stay healthy. These preventive actions not only keep women healthier, they keep families from ending up with astronomical payments. For example, mammograms detect cancer at an early and treatable stage. Without early detection, families often are faced with the huge medical bills that result from treating cancer in its advanced stages.
The eight new services are determined to play a significant role in preventing serious health complications for a large percentage of women in this country. Because they’re now free for millions of women with non-grandfathered insurance plans, these women are much more likely to utilize these services than they would have previously. If you are one of the 43 percent of women who put off necessary care, this is extremely good news. Check with your insurance provider to see if these services are free for you. If your insurance provider informs you that you have a grandfathered plan, it’s likely you have only a small co-pay for many of these services. Ask your provider, and don’t be deterred from getting the care you need by a $20 co-pay or a small co-insurance payment.

8 New Free Preventive Services for Women
(see “Grandfathered Plans” for coverage regulations)

1. At least one Wellness/Preventive care visit per year to obtain recommended preventive services. Several visits may be necessary to receive all necessary preventive services, depending on a woman’s health status, and other risk factors.
2. The full range of Food and Drug Administration-approved contraceptive methods, sterilizations procedures (check availability with your provider), and patient education and counseling for women with reproductive capacity. [Almost half of pregnancies in 2001 were considered unintended. Women with unintended pregnancies are more likely to received delayed or no prenatal care and to smoke, consume alcohol, be depressed, and experience domestic violence during pregnancy. It also increases the risk of babies being born preterm or at a low birth weight, both of which raise their chances of health and developmental problems.]
3. Screening for gestational diabetes in pregnant women between 24 and 28 weeks of gestation and at the first prenatal visit for pregnant women identified to be at high risk for diabetes. [The U.S. has the highest rates of gestational diabetes in the world; it complicates as many as ten percent of pregnancies each year. Women with gestational diabetes face a 7 ½ times greater risk of developing Type 2 diabetes after delivery and are more likely to require cesarean sections and have infants that have health problems after birth.]
4. Breastfeeding support, supplies, and counseling. Comprehensive lactation support and counseling by a trained provider and costs of renting breast-feeding equipment.
5. Annual counseling on sexually transmitted infections for sexually active women.
6. Annual counseling and screening for human immunodeficiency virus (HIV) infection for sexually active women.
7. The addition of high-risk human papillomavirus DNA testing in addition to cytology testing in women with normal cytology results (cervical cancer prevention). [Screening should begin at 30 years of age and should occur every 3 years or longer, as determined by your provider.]
8. Screening and counseling for interpersonal and domestic violence. [This includes discussion with adolescents and women of current and past violence and abuse in a supportive manner, addressing health and safety concerns. Approximately five million women are physically, sexually, or emotionally abused by their partners each year in the United States. Screening for risk is central to women’s safety, and is an important health consideration, as well.]

In all, there are 22 free preventive services for women. The following 14 services have been in place since Sept. 2010.

1. Anemia screening on a routine basis for pregnant women.
2. Bacteriuria urinary tract or other infection screening for pregnant women.
3. BCRA gene test counseling for women at higher risk of breast cancer.
4. Breast Cancer Mammography screenings every 1 to 2 years for women over 40.
5. Breast Cancer Chemoprevention counseling for women at higher risk.
6. Cervical Cancer screening for sexually active women.
7. Chlamydia Infection screening for younger women and other women at higher risk.
8. Folic Acid supplements for women who may become pregnant.
9. Gonorrhea screening for all women at higher risk.
10. Hepatitis B screening for pregnant women at their first prenatal visit.
11. Osteoporosis screening for women over age 60 depending on risk factors.
12. Rh Incompatibility screening for all pregnant women and follow-up testing for women at higher risk.
13. Tobacco use screening and interventions for all women, and expanded counseling for pregnant tobacco users.
14. Syphilis screening for all pregnant women or other women at increased risk.

Explanation of Grandfathered Plans

Under the Affordable Care Act (ACA) some “grandfathered” plans (group or individual private insurance plans that you’ve had continuously from March 23, 2010 or before) are not required to provide these women’s preventive services without a co-payment or deductible. If these plans make significant cuts to benefits or significant increases in cost, they lose their grandfathered status. The thought is that those insured patients who are happy with their current plan should be able to keep it. If not, they should be able to shop for a good quality, low cost plan.
In 2014, everyone will have many more health insurance choices (whether you’re shopping for an individual plan or the business you work for is purchasing a new plan for it’s employees) when the more competitive and affordable “insurance exchanges” come into play.
The reasoning behind the grandfathering of consistently reasonable and fair insurance plans is that many of these large group plans already provide most of the benefits of the ACA regulations. Although the “no cost” prevention services are not a part of these plans, they typically have low co-pays and good benefits. These plans will be monitored, however, to make sure that they maintain their high level of benefits and that they don’t increase co-insurance charges (for example, 20% of a hospital bill). Also, they can’t significantly raise co-payments or deductibles. They can’t significantly lower employer contributions, nor can they add or lower an annual limit on what the insurer will pay for covered services each year.
All grandfathered plans do have to cover many of the ACA provisions, though, including: allowing adult children to stay on or come on to parents’ policies until age 26; bans against lifetime limits and rescissions (people with individual coverage who each year pay their premiums, but lose their coverage just when they are likely to run up big medical bills); bans against waiting periods of more than 90 days; and, spending no less than 80 percent of premiums on medical costs (small group and individual markets) or 85 percent in large group employer plans.
The approximately 130 million Americans who have large employer sponsored health insurance (over 100 employees) are likely to have “grandfathered” plans. These plans won’t cover the ACA preventive services with no out of pocket cost, but it’s likely that the co-pays for these services are already very low, and that most if not all of these services are covered. .
Roughly 43 million Americans are insured through smaller businesses, which are likely to give up their grandfathered status over the next year or two if they haven’t already. Small plans tend to make substantial changes to charges and benefits, so these employees are likely to gain the ACA protections sooner.
The 17 million people who have individual health insurance coverage, are likely to have seen changes already or will do so over the next year or so. That’s because substantial changes in coverage is common. These people are most likely to need and to receive the protections offered by the ACA currently or in the near future.
Beginning in 2014, with the advent of Health Insurance Exchanges, individuals and small business employees will be offered a much greater choice of plans at more affordable rates. These plans will avail themselves of all the ACA protections.

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