Under a new administrative approach announced today by President Obama, insurance companies offering coverage in the individual market will be able to renew plans that do not include all of the consumer protections required under the Affordable Care Act. In making decisions about their health insurance coverage, women who live in states that permit this approach should be alert to the costs of keeping their current plan versus finding a new plan through the health insurance marketplace. These are five things women should learn about their current insurance policy before deciding to remain with their plan:
- Whether the plan charges more to women. The practice of gender rating, or generally charging women more for the same coverage, costs women in the individual health insurance market approximately $1 billion a year. If a woman remains enrolled in her individual market health insurance plan, she may be paying more than men for comparable coverage.
- Whether the plan includes maternity coverage. Only 12 percent of health insurance plans sold in the individual market include maternity coverage. As a result, some women do not have the coverage they need when they become pregnant. If they look to buy a maternity rider, they may face a waiting period of one or two years. Once a woman decides to start a family or if she becomes pregnant, she may not have coverage for pregnancy.
- Whether the plan denies coverage for preexisting conditions. Insurers have deemed women to have a pre-existing condition if they previously gave birth by Caesarean section; are pregnant at the time they seek coverage; survived domestic violence and received treatment related to abuse; or received medical treatment after sexual assault. The health care law ends this practice for new plans, but if a woman remains in a plan that continues to have a preexisting condition exclusion, the plan may decide a condition is preexisting once a woman gets medical care and finds she needs insurance the most.
- Whether the plan charges more because of an existing or past medical condition. The health insurance law includes a fair health insurance rating provision, which means that new plans cannot charge higher premiums to people who are sick, leaving only healthy people with affordable coverage. However, if a woman renews an individual insurance plan, then that plan can continue to charge higher premiums to women with chronic conditions.
- Whether the plan has high out of pocket costs. The health care law requires all new plans in the individual market to have a maximum amount – known as an out-of-pocket limit – the individual or family would need to pay towards covered medical costs. One-third of health plans offered in the individual market have limits that are higher than those allowed under the health law. It is important for women to know what their out of pocket costs are because approximately 10 million Americans with health insurance have medical bills they are unable to pay.
Women enrolled in individual market coverage today need to learn whether their current plan includes the protections required by the Affordable Care Act. All plans sold in the new health insurance marketplace will include important protections for women, including fair premium rating and no gender rating, maternity coverage, coverage of preexisting conditions and limits on out of pocket spending. Women who are enrolled in coverage in the individual market should compare their current coverage — including premiums, limitations, exclusions and cost sharing limits — to plans available through the health insurance marketplace at healthcare.gov.