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Each autumn, as pumpkin spice flavors and trick-or-treaters make their annual appearance, another seasonal milestone arrives: Open Enrollment on the state and federal health insurance marketplaces (Healthcare.gov). Between November 1 and January 15, anyone can sign up for health insurance or switch plans. <\/p>\n
Health insurance may not be as much fun as other fall traditions, but making sure you have solid health insurance coverage can protect you financially when you need care. <\/p>\n
Thanks to the Affordable Care Act (ACA), sometimes called Obamacare, health insurance can be the key to unlocking access to women\u2019s healthcare \u2014 but only if you get the right kind of plan. Know what women\u2019s health benefits you\u2019re entitled to and how to get the best women\u2019s health insurance coverage for you.<\/p>\n
The Affordable Care Act (ACA) set new rules for health insurers. Before the ACA, health insurers were able to deny coverage for preexisting health conditions \u2014 something they can no longer do \u2014 and what you may not realize is that pregnancy and being a survivor of domestic violence, are considered pre-existing conditions. <\/p>\n
Another change that came with Obamacare is that health insurers are also no longer allowed to charge women higher premiums than men. Before the ACA, women often had to pay 30% more than men. <\/p>\n
The ACA also requires insurers to cover a set of 10 essential health benefits (EHBs), which include some benefits specific to women\u2019s health. <\/p>\n
Before the ACA, only one out of every three women with individual health plans had birth control coverage. Today, all plans sold on the Health Insurance Marketplace and most other private health plans cover patient education and counseling, as well as FDA-approved birth control methods, without copayments or coinsurance. To get coverage, you must get a prescription from a healthcare provider (HCP) that participates with your health insurance plan. <\/p>\n
Birth control options covered by insurance include:<\/p>\n
It\u2019s always a good idea to check if your specific birth control method (such as a specific pill or device) is covered.<\/p>\n
There are some exceptions. For example, medications that induce abortions are not required to be covered, but specific health plans may choose to cover them.<\/p>\n
Health plans sponsored by religious employers can seek exemptions to these rules and opt not to cover contraceptives. If you work for a church or other religious organization with a stance against birth control, you may have to pay for contraceptives out of pocket. But you may still have coverage through a third-party benefits administrator. Check with your health plan or employer for details on your specific coverage.<\/p>\n
ACA-compliant insurance plans include coverage for pregnancy care and childbirth, as well as care for you and the baby after delivery. That wasn\u2019t always the case. Before the ACA, most women with individual health insurance didn\u2019t have maternity coverage.<\/p>\n
Prenatal care is a form of preventive care, which the ACA requires insurers to cover without copayments or other consumer costs (if you get services from participating HCPs). Although insurers have to cover these services, they are allowed to share the costs of giving birth with the patient, so you may have copayments or coinsurance for delivery. <\/p>\n
Being pregnant may qualify you for free- or low-cost coverage through Medicaid or the Children\u2019s Health Insurance Program (CHIP). Pregnancy may also allow you to enroll in marketplace health insurance plans outside of the open enrollment period. Being pregnant doesn\u2019t automatically trigger a special enrollment period, but having a baby does. Once you give birth, you can enroll in health insurance for the first time or switch plans. You can also get coverage for your baby and other household members. <\/p>\n
Life changes, such as moving or loss of coverage, can trigger a special enrollment period, which lets you sign up for health insurance whenever your situation changes. <\/p>\n
If you\u2019re breastfeeding, your ACA-compliant health plan must provide support and coverage for breastfeeding counseling\/lactation services and equipment. Specifically, health plans must cover the cost of a breast pump \u2014 either one that you rent or one that you\u2019ll keep. Health plans can vary in what types of pump they\u2019ll cover, how long you can have it for, and whether you can get it before you give birth or after. Sometimes, health insurers will only cover what your HCP says is medically necessary and may require that you get prior authorization \u2014 permission ahead of time \u2014 before they will cover these services and products. Talk to your HCP about their recommendations and how they may help you get covered benefits.<\/p>\n
Additional benefits health insurers must cover under the ACA include many services that women need, including:<\/p>\n
To make sure you get these benefits, you must be enrolled in an ACA-compliant plan, such as a qualified health plan \u2014 an insurance plan that\u2019s certified by the health insurance marketplace. These plans may be available on or off the marketplace. Avoid catastrophic, or \u201cskinny,\u201d plans, which do not have to meet the same coverage rules.<\/p>\n
If you get your health insurance through an employer, that employer may not be subject to all of the same rules. Ask your employer or benefits administrator if the plans they offer are ACA-compliant. If they\u2019re not, ask about the specific services you may need to make sure they\u2019re covered.<\/p>\n
Just because something is covered doesn\u2019t mean it\u2019s free. You may still have to pay a share of the cost, such as a copayment or coinsurance. But the rules mean that your health insurer can\u2019t set annual or lifetime limits on what they will pay for you to use EHBs, which was allowed before the ACA.<\/p>\n
You may also have to get permission, called prior authorization, for certain services before receiving them. Work with your health plan to understand the rules and with your HCP if you need help filling out the necessary requests.<\/p>\n
Health insurance can be a headache, but especially for women, it can be a lifeline \u2014 and a money saver.<\/p>\n