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2010 Health Care Reform Law Changes in Benefits and Coverage For Women

How The The Affordable Care Act Saves Women Money On Health Care in 2010

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According to a White House press release on women and health care, "more than half of women report delaying needed care because of cost, and one-third of women were forced to make a difficult trade-off such as giving up basic necessities in order to get health care." The release also reported, "Less than half of women have the option of obtaining health insurance through a job."

The Affordable Care Act (Act), addresses many complex insurance issues including insurance rescission (retroactively canceling insurance coverage after a claim is filed), denial of coverage for preexisting health conditions, lack of coverage for prescription medication, and preventive care. It also addresses unfair pricing structures. For example, today, a healthy 22-year-old woman can be charged premiums 150 percent higher than a 22-year-old man simply because she is a woman.

Here are some of the ways the Act will help women obtained more equitable and affordable health care coverage.

How The The Affordable Care Act Saves Women Money On Health Care in 2010

Overall, the cost of health care for women will decrease more than for men because historically, women pay more for less coverage, but both men and women will benefit from the Act.

Elimination of Lifetime Limits on Benefits: In 2010, the Act eliminates all lifetime limits on how much insurance companies cover if women get sick. For example, a woman with breast or ovarian cancer can no longer have be denied benefits because the cost of treatment exceeded a lifetime cap.

Dropping Coverage and Retroactively Canceling Insurance is Illegal: The Act makes it illegal to drop women from coverage if they get sick or pregnant. Insurance recission is already illegal in some states, however, even in states where rescission is illegal the practice is widespread. For example, when a woman is diagnosed with a serious or expensive medical condition, her insurance companies may go back and look at the insurance policy application to see if any information was omitted or misleading. If they can find a reason to rescind the policy, they will deny the claim and retroactively cancel her insurance coverage. This may sound like a fair way to protect insurance companies from women who lie about their health history to get coverage, but insurance companies may deny treatment for totally unrelated medical conditions such as failing to report a doctor's visit ten years prior for a stomach ache as a reason to deny coverage for a hysterectomy.

Restrictions on Annual Limits: The Act restricts annual limits in all new plans and existing employer plans in 2010. In 2014 all annual limits for these plans will be prohibited.

Health Insurance Exchanges: Once new Health Insurance Exchanges are available, all new plans will have a cap on what insurance companies can require people to pay in out-of-pocket expenses, including on co-pays and deductibles. A "health exchange" allows the unemployed and those seeking to buy insurance for themselves to purchase insurance through marketplace pools. Health exchange insurance pools do not provide insurance, they use the buying power of combined consumers to facilitate the purchase of private health insurance - not government insurance coverage.

Medicare Gap Rebate: Medicare beneficiaries who hit the "doughnut hole," a gap in coverage, are eligible for a rebate of $250.00.

Mandatory Coverage For Preventive Care and Well-Visits: New health plans are now required to cover preventive care and wellness benefits, like pap smears, mammograms, and well-child visits, at no charge by exempting these benefits from deductibles and other cost-sharing requirements.

Coverage Cannot Be Denied For Preexisting Conditions: The Act now, prohibits insurance companies from denying children coverage based on preexisting conditions. In coming years, this requirement will be extended to adults as well. However, in 2010, the Act provides access to affordable insurance for uninsured adults with preexisting conditions through a temporary subsidized high-risk pool.

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