The Affordable Care Act (ACA), also referred to as Obamacare, aims to eliminate the discriminatory practices in coverage and care that have plagued women’s health for decades. Women now enjoy the same health benefits and insurance as men, and all insurance plans must cover maternity care under the ACA. Here are some specific reasons that women benefit greatly from the Affordable Care Act .
- Women can’t be charged more than men—In the past, discriminatory practices such as “gender rating” and the treatment of pregnancy as a preexisting condition were rampant, due to the fact that women’s health needs—in large part because of the cost of childbirth—are comparatively higher than men’s. Many pre-ACA plans lack maternity coverage, and those that do have it often come with long waiting periods and deductibles that negate their benefits.
- Free birth control—On August 1, 2012, the contraception mandate portion of the Affordable Care Act went into effect. This means that almost all employers with >50 employees are legally required to provide contraceptive coverage as part of employer-sponsored or group plans. This includes coverage for all FDA-approved birth control methods, follow-up appointments, side effect management, and device removal.
Organizations whose sole purpose is religious activity, like churches, are exempt from the requirement of providing contraceptives to their employees. Nonprofit organizations that are religiously affiliated are allowed to refuse. The question remains of whether for-profit employers with owners that have personal objections can challenge the mandate via a “conscience clause.” In light of the constant media attention and politics around this issue, here is what you need to look into in order to receive this benefit:
- Plans that started or were created before March 23, 2010 are grandfathered, which means that they do not have to abide by the mandate until January of 2014. Use this telephone script by the National Women’s Law Center to find out if your insurance will provide contraception coverage.
- Each plan is only required to cover one offering of each type of FDA approved contraception method. These methods include the pill, injectables (depo provera), the ring, implant, IUD, barrier methods, and nonsurgical permanent contraception (Essure). Check with your insurer whether the brand or manufacturer you prefer is covered.
- Six states—AZ, AR, GA, ID, MS, SD—have laws that allow healthcare providers and pharmacists to refuse to provide contraceptive services if they object for personal or religious reasons. If you will be getting postpartum contraception from a local pharmacy, make sure they will agree to it.
- Pregnancy coverage—The new maternity care provision will include routine prenatal care visits (for free!), the costs of hospitalization for childbirth including complications, and postpartum care for both you and your newborn.
Coverage also includes affordable:
- Co-pays for ultrasounds
- Cost sharing of genetic screening
- Co-pays for noninvasive fetal testing
- Deductibles for hospitalizations that occur during pregnancy for conditions such as threatened preterm labor, hypertensive disorders, or premature breakage of the amniotic sac.
- Anesthesia services during labor and delivery, including intravenous pain medications for early labor and regional anesthesia later in labor (such as an epidural).
- Free well-woman visits—at least one free well-woman visit a year is required of all health plans. This represents another step towards equalizing care for women; a recent Commonwealth Fund study showed that upwards of 43% of American women (both insured and uninsured) report missing routine preventive care because of costs, more than was observed in ten other industrialized countries.
Whether you are considering getting pregnant or not, a well-woman visit is an opportunity to diagnose and manage new chronic illnesses such as high blood pressure, hypothyroidism, diabetes, or asthma, which can greatly affect not only a pregnancy, but also your long-term health.
- Breastfeeding services covered—Exclusive breastfeeding for the first 6 months of life has been strongly endorsed by a number of authoritative bodies because of its numerous maternal and infant benefits. The Affordable Care Act requires breastfeeding supports without cost-sharing. These supports include counseling, consultations with trained lactation consultants, and equipment rental. Keep in mind that the interpretation of these benefits is highly dependent on the discretion of your insurance provider.Many women wait until they have given birth to inquire about the details of breastfeeding benefits with their insurance providers. This is not only a very challenging and sleep-deprived period of time to attempt setting up the logistics of vendors, deliveries, and insurance claims, but it can lead to delays that deter exclusive breastfeeding. Getting your breastfeeding plan set up early on by looking into your benefits in advance will allow you to have the best chance at maximizing the benefits of human milk.
Dr. Chitra Akileswaran is a Harvard-trained OB/GYN and advocate of affordable healthcare.
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