Women’s Health Insurance Guide to 2022

Women’s health coverage

In the case of U.S. women, access to affordable coverage in the individual health insurance market has significantly improved over the past decade, largely due to coverage improvements provided by the Affordable Care Act and consumer protection.

Prior to the introduction of the ACA, which began largely in 2014, women faced many barriers to coverage:

  • Previously, more than half of individual plans charged higher premiums to a 40-year-old non-smoker than a 40-year-old male smoker for the same coverage.
  • More than 90% of individual health plans did not provide regular maternity benefits.
  • Except in five states, pregnancy was a pre-existing condition that prevented a woman from purchasing individual health insurance.
  • Many individual health plans did not provide contraceptive coverage.
  • Coverage for women’s preventive care varied significantly from state to state.

Recommended reading:

We look forward to using this guide to help you understand how coverage has improved, and what to expect when it comes to selecting women’s health care coverage.

Prevention of ACA-dependent women

Before the Affordable Care Act was enacted, the coverage of women’s preventive care varied greatly from state to state. But as of August 2012, all health plans (except grandparent plans) were required to provide coverage for certain categories of preventive care for women:

  • Welcome to visit women
  • Monitoring Diabetes in Pregnancy
  • HPV test
  • Screening and counseling for domestic violence
  • HIV testing and counseling on sexually transmitted infections
  • Breastfeeding supplies
  • Contraceptives and family planning advice

(Please note that additional preventive care mandates came into force in 2014, including preventive care for children and all adults, as well as specific additional preventive care for women).

Coverage of women’s health services

Maternity care coverage

Prior to 2014, only 12% of individual market health plans had maternity benefits. But the Affordable Care Act has been a game changer. Maternity care is one of the essential health benefits to be included in all individual and small group policies.

This means that a waiting parent can get coverage in all states in open enrollment or in a special enrollment period initiated by a qualifying event. And women don’t charge higher premiums than men, even though all new health insurance policies include maternity coverage.

Coverage of infertility treatments

Infertility Care is not one of the essential benefits of the Affordable Care Act, and coverage for infertility treatment is not mandated by the ACA or any other federal law. But some states have rules that go beyond the minimum requirements set by the federal government in their laws, regulations, and mandates.

These state rules apply only to state-regulated plans, which include health plans that individuals and businesses purchase from an insurance company. But self-insured employer-sponsored health plans are not subject to state insurance rules.

Recommended reading:

Abortion coverage

Abortion coverage is neither necessary nor prohibited under the ACA. But federal funds cannot be used to pay for abortion unless the situation involves rape, incest, or the risk to the mother’s life. Coverage for other abortions varies significantly from one health plan to another.

Contraceptive coverage

The Affordable Care Act improved access to effective long-term contraceptives without cost barriers. According to the ACA, health policies that were enacted on or after August 1, 2012 — without cost-sharing — are required to cover at least one version of each FDA-approved method of contraception for women. This includes sterilization, IUDs, and implants, which were often significant costs before the ACA.

Recommended reading:

Latest news

Access to women’s health services was greatly expanded according to the ACA. This was not because of the ACA’s coverage orders (for things like preventive care and maternity), but also because the ACA has much more health coverage. This includes access to Medicaid coverage, employer orders, and subsidized coverage in exchange for health insurance.

But women’s health coverage and care remains a controversial issue, and rules continue to evolve over time.

Leave a Comment