Study: The value women receive in health benefits under Obamacare worth more than cost of annual health insurance premiums
The most recent Obamacare enrollment numbers indicate that significantly more women than men are purchasing health insurance plans under the Affordable Care Act (55% of enrollees are female, 45% are male). NerdWallet Health analyzed the cost of women’s health services as one factor in a woman’s decision to enroll in new health insurance coverage. We found that the cost of paying out of pocket for recommended annual women’s preventive care services and oral contraceptives is roughly equivalent to the cost of purchasing health insurance for one year. Because these women’s health services and contraceptives are provided with all ACA plans, the cost of insurance is therefore essentially “free” for women.
NerdWallet’s calculations estimate that women who receive the standard recommended preventive care and take contraceptives will find significant value in having health insurance. With the out-of-pocket cost of women’s health services equating to more than the annual premium cost of health insurance, health insurance is a great deal for women. Insured women will receive recommended care plus annual coverage for less cost than uninsured women will pay for similar preventive services. This makes purchasing insurance well worth it for many women.
- The total estimated cost of receiving recommended annual preventive services and taking oral contraceptives for an uninsured woman is $1,231 (preventive services include one well-woman visit, an HIV test and a Pap smear).
For a 27-year-old who earns an income of $25,000, the cost of a Silver insurance plan will be approximately $1,740/year, and a Bronze plan will cost approximately $1,116/year.
- Standard preventive services and contraceptives are free for women with qualified health plans, no matter the metal tier.
- Given this analysis, many newly insured women will find that the price they pay for health insurance, including mandated coverage of women’s health services, is less than the price they would pay out of pocket to acquire these same services without any health insurance coverage.
- Many women already access preventive services and take contraceptives: 62.2% of women of reproductive age use birth control, 66.7% get a yearly preventive care checkup, 81.8% receive recommended cervical cancer screening and 41% get tested for HIV. We predict that these numbers will increase as more women become insured and thus have complimentary access to these services.
Annual Cost of Standard Women’s Health Services for Uninsured Patients
|1-year supply of Yasmin oral contraceptive||1 well-woman visit||Pap smear (cervical cancer screen)||HIV lab fee||Blood draw||Total/year|
Source: NerdWallet Health analysis. GoodRx. American Medical Association. Centers for Medicare & Medicaid Services.
Note: Cost of services for uninsured patients are assumed to be equivalent to un-negotiated list prices of given health services.
Prior to the ACA, many women were subject to “gender rating,” in which insurance companies would charge women different premiums than men. According to Christina LaMontagne, VP of Health at NerdWallet, “the ACA represents a significant step toward equality in the cost of health care across gender lines. Some 92% of pre-ACA plans practiced gender rating, a practice that is now banned—and only 3% of these plans covered maternity services.” The reforms brought on by the ACA fix both of these problems: gender rating is no longer allowed and pregnancy must now be covered. In addition, there is an extended list of free preventive benefits that insured women now have access to.
This study investigates the financial impact of expanded women’s health benefits. Many women will find that purchasing insurance costs the same as, or even less than, paying out of pocket for preventive services and contraceptives. What’s more, being insured gives women access to pregnancy coverage, protection in case of emergency and many preventive benefits beyond those listed in this study. Says LaMontagne, “ACA health insurance plans are a great deal for American women. As we move toward a health care model based on prevention, the importance of taking advantage of preventive benefits can not be emphasized enough. Getting insured has always been important for protecting your finances, but these new provisions put in place by the ACA go a step further by preventing disease—and, in turn, improving the health of the nation. Women stand to benefit to an even greater extent, and should take this opportunity to not only purchase affordable insurance, but also to take charge of their health by receiving recommended care.”
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Infographic by Brian Yee.
Cost of health insurance: U.S. Department of Health and Human Services Health Insurance Marketplace Premiums for 2014. Prices reported are averages for the 36 states on the federal health insurance Marketplace. Silver plan price is for the second-lowest-cost Silver plan after tax credits. Bronze plan price is for the lowest-cost bronze plan after tax credit.
Cost of services for uninsured women: Average costs were determined by averaging the cost of services across the five largest cities in the U.S. We assumed that an uninsured woman would not have received an HIV test or Pap smear before, so both of these services would be recommended.
- Cost of well-woman visit: Estimated for one preventive health visit at a facility (hospital, ambulatory surgical center or skilled nursing facility). Medicare fee schedule rates from the American Medical Association were scaled to out-of-pocket values using the average Medicare discount.
- Cost of lab tests: The 2014 Medicare Clinical Laboratory Free Schedule was used to determine price estimates for HIV lab test, blood draw and Pap smear. Values were scaled to out-of-pocket values using the average Medicare discount.
- Cost of contraceptives: Cost for one-year supply of Yasmin was determined across five largest cities using GoodRx. The cash price at CVS was used.
Woman and doctor photo courtesy of Shutterstock.