Women shopping for individual health insurance have had a tough time in the past because many plans did not cover maternity care, charged women more money and even denied coverage.
But federal health care reform will prohibit these practices, and leaders of a new research project are urging states to pay close attention to women’s health needs when setting up exchanges, the online marketplaces where consumers will shop for insurance.
The Women and Health Reform Project – a collaboration of Brigham and Women’s Hospital, the Jacobs Institute of Women’s Health and the Kaiser Family Foundation – offers a checklist that states can use to make sure women will be to be able to get good, affordable care for themselves and their families.
Here are six of the items on the checklist.
1. Benefits offered by the plans.
The federal health care reform law requires that all health plans sold in the online exchanges offer 10 categories of benefits, including maternity care, emergency services, hospitalization, mental health and substance abuse services, and prescription drug coverage.
Many of the specifics are left up to states to decide as they set up their exchanges, says Therese Fitzgerald, director of the women’s health policy and advocacy program at Brigham and Women’s Hospital. The Women and Health Reform Project wants states to make sure plans in the exchanges offer a broad range of health care throughout a woman’s life, including reproductive health, menopause and elder care, Fitzgerald says.
“Our concern is making sure the entire lifespan is addressed,” Fitzgerald says.
2. Network of providers.
Women use more primary care than men, and also are more likely than men to use reproductive and mental health services, according to WomenandHealthReform.org. So, it’s important that the plans in the exchanges offer a broad network of health care providers to meet these needs, Fitzgerald says.
To make sure plans have adequate networks of providers, states should consider setting provider-to-patient ratios for certain medical specialties, as well as setting standards to make sure patients don’t have to drive too far or wait too long to get an appointment or see a doctor. “That’s key to the consumer experience,” she says.
3. Preventive services.
The health care reform law requires health insurance plans to offer certain preventive services for free with no out-of-pocket costs. Free preventive services for women include “well woman” doctor’s visits, contraception, gestational diabetes screening, and breastfeeding support and supplies, according to HealthCare.gov. Sexually active women also can get counseling and screening for sexually transmitted infections, including HIV.
But the exchanges will need to offer education, Fitzgerald says, and make it clear to consumers that they don’t have to pay for these services. And states need to make sure plans in the exchanges are complying with the new law and offering all of these services at no cost, says Claire McAndrew, senior health policy analyst at the nonprofit Families USA. “States need to keep an eye out,” she says.
4. Maternity care.
All plans in the exchanges will offer maternity care, as required by the federal health care form law. States should make sure the plans offer a range of types of facilities and providers, such as nurse midwives and free-standing birthing centers.
“We want to make sure women have choices in the way they design their birth plan for their unique maternity needs,” Fitzgerald says.
Leaders of the Women and Health Reform project also say states should define maternity care to include pre-conception – for example, genetic and nutrition counseling before pregnancy – as well as prenatal care, delivery, postpartum care and services needed between pregnancies.
5. Chronic health conditions.
Women suffer more chronic health conditions and are more likely than men to have multiple chronic health conditions – for example, heart disease and diabetes, says Laura Cohen, senior health policy analyst at Brigham and Women’s Hospital. Also, compared with men, women suffer higher rates of depression, anxiety and eating disorders, so states should require plans to offer adequate numbers of therapy visits, length of treatment and different types of mental health treatment. “We want to make sure the services offered are comprehensive and robust enough to really get a person well,” Cohen says.
6. Affordability and transparency.
The exchanges should be set up so that consumers can see what they’re buying and get a plan they can afford, project leaders say. Families USA wants states to make sure consumers don’t have so many choices that they’re overwhelmed, McAndrew says.
Plans in the exchanges will be offered at four coverage levels – platinum, gold, silver, and bronze – and McAndrew recommends states limit insurance companies to selling, for example, three plans at each level.