The Affordable Care Act has helped improve women’s access to healthcare since it became law in 2010. Now women can find the best health insurance for their personal circumstances rather than being limited to whatever coverage will approve their application.
Before the ACA was enacted, sex-specific health issues, including pregnancy, past pregnancy and even experience with sexual assault, were frequently barriers to affordable health insurance for women enrolling in non-workplace coverage.
One-third of women who tried to buy an individual major medical insurance plan were either turned down, charged a higher premium because of their health or had specific health conditions excluded from their plan.
The healthcare reform law transformed this reality. Women can no longer be charged more than men for the same policy, and coverage is guaranteed issue — you can’t be denied or charged more due to your health history. Additionally, Medicaid expansion and the repeal of the ACA’s individual mandate penalty have given women more avenues through which to obtain healthcare coverage.
From 2008 to 2018, the number of uninsured women in the U.S. has decreased from 18% to 11%, respectively. The majority of women (about 60%) ages 19 to 64 still obtain coverage through an employer-sponsored health insurance plan. Others get benefits through Medicaid (17%), a direct purchase plan (i.e., individual major medical) or another form of coverage such as military benefits or non-elderly Medicare (8%), or Medicare (3%).
Here, we will take a closer look at three health insurance coverage options for obtaining the best women’s health services: ACA plans, short-term medical plans and Medicaid.
1. How ACA Plans Cover Women
Individual major medical plans, which are sometimes called ACA plans, include a broad range of benefits from preventive care services to hospitalization. A number of these benefits are specific to women’s health.
All ACA plans include services within 10 categories of essential health benefits, including pregnancy and childbirth. They must also include certain no-cost preventive care benefits, which means you cannot be charged a copay or coinsurance for these services, even if you haven’t reached your annual deductible.
A large number of these preventive services are women-specific; examples are as follows:
- Breast cancer mammography screenings every 1 to 2 years for women over 40.
- Cervical cancer screening every three years for women 21 to 65.
- Well-women visits for women under 65.
Given these required benefits, an ACA plan can meet women’s healthcare needs throughout their reproductive years and into menopause.
Is an ACA plan best for you?
Subsidies, including premium tax credits that reduce your monthly payments and cost-sharing reductions that lower out-of-pocket costs such as your deductible, can help make ACA plans an affordable insurance option. You have to qualify based on income and must purchase your ACA plan through a state-based or federal health insurance exchange.
An ACA plan is probably the right choice if you:
- Qualify for an ACA subsidy.
- Don’t qualify for Medicaid.
- Plan on becoming pregnant.
- Have pre-existing conditions or ongoing healthcare concerns.
You can enroll in an ACA plan during the annual open enrollment period or during a special enrollment period when you experience a qualifying life event such as having a baby.
When you find yourself uninsured outside of open enrollment and can’t qualify for a special enrollment period, or don’t qualify for a subsidy and can’t otherwise afford coverage, you may want to consider short-term medical insurance or Medicaid.
2. Short-Term Medical Insurance + Women’s Health
Short-term medical insurance provides temporary benefits when you’re in between individual or group major medical plans. It doesn’t typically cover women’s health; however, that’s about to change with a new generation of plans entering the marketplace.
Now women can enroll in a short-term policy that includes the following non-standard benefits:
- Multiple preventive care visits.
- Immunizations paid at 100%.
- A supplemental accident insurance option.
Regardless, a short-term plan still won’t cover the full scope of women’s health services included in an ACA plan. It’s not supposed to. Short-term plans are designed to provide an economical option that meets temporary health insurance needs — 30 to 364 days, depending on your state of residence.
While lower premiums are achieved through limited benefits, short-term health plans do cover a range of medical costs associated with accidents and unexpected illnesses. Coverage varies, but short-term plans typically include benefits for emergency room visits, hospital stays, doctor appointments and surgery. Some may even include additional non-insurance benefits such as prescription drug discounts, telemedicine, and dental and vision discounts. You’ll want to pay close attention to plan details when making your decision.
There is no open enrollment period for short-term health insurance. You can buy it online, year-round and, if your application is approved, coverage can begin as soon as the next day. Policies last 30 to 364 days, depending on your state of residence and personal need.
Is short-term health insurance best for you?
Because they help balance the need for cost-effective coverage with benefits for the unforeseen, short-term health insurance can be especially useful to women who are in between major medical policies.
You might also consider short-term health insurance if you:
- Don’t qualify for a subsidy and can’t afford an ACA plan.
- Can’t get Medicaid.
- Missed open enrollment for ACA plans and don’t qualify for a special enrollment period.
- Need long-term coverage.
While you may also be eligible for COBRA or an ACA special enrollment period in these situations, some life circumstances in which short-term health insurance might be an option include:
- Being in between jobs with benefits.
- Waiting for coverage, job-based or otherwise, to begin (e.g., an employer waiting period).
- Retiring before Medicare eligibility.
- Turning age 26 and transitioning off a parent’s health plan.
- Being self-employed or working a job without benefits.
- Going through a divorce and losing coverage through a spouse.
Immigrant workers who have lost a job or can’t afford an ACA plan are another population that might consider short-term coverage. To qualify, citizenship isn’t required but you need to have lived in the U.S. for 12 months.
Of course, short-term health insurance is not right for everyone. Policies are not guaranteed issue, which means you can be denied coverage based on health history and may not qualify if you have pre-existing conditions.
Additionally, a short-term plan may not be a good fit if you:
- Want all of the essential health benefits.
- Live in a state where short-term health insurance isn’t available.
- Need benefits for pregnancy and childbirth.
If you qualify for an ACA subsidy or Medicaid, you should consider those options first.
Medicaid provides low-cost or no-cost coverage to many populations, including low-income adults and pregnant women. In fact, women comprise the majority of adult Medicaid beneficiaries (36%). Of the 25 million adult women covered by Medicaid, 67% are 19 to 49 years old.
Medicaid is the largest public payer for family planning services. More than half of all U.S. births are covered by the program, which provides prenatal and maternal care. However, the program’s benefits extend beyond reproductive health and include care relevant to all facets of women’s health.
Primary and preventive care. Examples include Pap tests and mammograms.
Mental health. Medicaid is the primary payer of mental health services in the U.S. and covered nearly 1 in 4 adult women with any mental illness and 28% of adult women with serious mental illness in 2015.
Cancer. States may extend coverage for cancer treatment to uninsured women diagnosed with breast cancer or cervical cancer through a federal screening program and receive a match for those services.
Physical and mental disabilities. Coverage also helps women with physical and mental disabilities such as severe mental illness, muscular dystrophy, cystic fibrosis and AIDS. It also offers aging and long-term care to dual-eligible adults, those age 65 and older who qualify for both programs as well as younger people with serious disabilities and very low incomes. Women account for 60% of dual-eligible beneficiaries.
Medicaid is administered by states according to guidelines set by the federal government. Each state Medicaid program must provide mandatory benefits such as inpatient and outpatient hospital benefits, physician services, laboratory and X-ray services. States can also choose to include other optional benefits such as prescription drugs benefits, physical therapy and occupational therapy.
Is Medicaid best for you?
While Medicaid is available year-round, not everyone qualifies for it. Thirty-seven states, including the District of Columbia, have expanded Medicaid to those with incomes at or below 133%. Otherwise, you must meet your state’s program criteria.
If you do qualify for Medicaid, then it is likely the best health insurance plan for you due to its cost and comprehensiveness. Those who don’t qualify for Medicaid or are losing Medicaid should look into an ACA plan with subsidies, or consider a short-term medical plan.
How to Choose the Right Health Plan for You
Finding the best health insurance coverage can be a difficult task. There’s no one plan that’s right for every woman, which is why you will want to shop around.
Some key steps in the decision-making process include:
- Consider your overall budget for monthly premiums and out-of-pocket costs.
- Gather premium quotes for a variety of plans.
- Compare plan details, especially those relevant to your ongoing healthcare needs (e.g., prescription medications).
- Determine eligibility for subsidies and coverage, as applicable.
As you research and compare coverage options, be sure to look at out-of-pocket costs in addition to monthly premium. If you need healthcare, can you afford the policy’s deductible and coinsurance amounts? As a general rule, plans with a lower monthly deductible tend to come with higher out-of-pocket costs and vice versa.
Consider your personal healthcare needs as well — they can change from year to year. Will the plan you’re considering be adequate? For example, if you plan on becoming pregnant, be sure to choose health insurance that includes benefits for pregnancy and childbirth.
Contact health insurers to ask plan-specific questions, and consult a licensed health insurance advisor if you need help determining your options and selecting coverage.