Executive Summary

Women continue to face unfair and discriminatory practices when obtaining health insurance in the individual market—as well as in the group health insurance market. Women are charged more for health coverage simply because they are women, and individual market health plans often exclude coverage for services that only women need, like maternity care. Furthermore, insurance companies—despite being aware of these discriminatory practices—have not voluntarily taken steps to eliminate the inequities. While some states have outlawed or limited these practices, only when the Affordable Care Act is fully implemented in 2014 will they end nationally. The National Women’s Law Center’s research in 2012 showed that:

  • Gender rating, the practice of charging women different premiums than men, results in significantly higher rates charged to women throughout the country. In states that have not banned the practice, the vast majority, 92%, of best-selling plans gender rate, for example, charging 40-year-old women more than 40-year-old men for coverage. Only 3% of these plans cover maternity services.
  • Based on an average of currently advertised premiums and the most recent data on the number of women in the individual health insurance market, the practice of gender rating costs women approximately $1 billion a year.
  • There is such wide variation in differences women are charged both within and across states—even with maternity care excluded—that it is difficult to see how actuarial justifications could explain the difference. For example, one plan examined in Arkansas charges 25-year-old women 81% more than men for coverage while a similar plan in the same state only charges women 10% more for coverage than men.
  • There is also wide variation in differences women are charged across insurance companies. For example, one insurance company charges 40-year-old women an average of 20% more than men for the same coverage while another company charges 40-year-old women an average of 50% more than men for the same coverage.
  • Even with maternity coverage excluded, nearly a third of plans examined charge 25- and 40-year-old women at least 30% more than men for the same coverage and in some cases, the difference is far greater. For example, one company charged 25-year-old women 85% more than men for the same coverage, again excluding maternity coverage altogether.  These differences result in women paying significantly more for health insurance every year than their male counterparts.  For example, one plan in South Dakota charges a 40-year-old woman $1252.80 more a year than a 40-year-old man for the same coverage.
  • In most states, it is common for a female non-smoker to be charged more than a male smoker simply because she is a woman. For example, 56% of best-selling plans charge a 40-year-old woman who does not smoke more than a 40-year-old man who does smoke.
  • Gender rating also occurs in the group market, where businesses with predominately female workforces are routinely charged more for group coverage.
  • Maternity coverage is largely unavailable in the individual market. In states where it is not mandated, only 6% of the health plans available to a 30-year-old woman provide maternity coverage. Even when states that mandate maternity coverage are included in the calculation, the number only reaches 12%.
  • Fourteen states have taken steps to ban or limit gender rating in the individual market. These states are California, Colorado, Maine, Massachusetts, Minnesota, Montana, New Hampshire, New Mexico, New Jersey, New York, North Dakota, Oregon, Vermont, and Washington. Seventeen states have laws banning or limiting gender rating for group health plans. These states are California, Colorado, Delaware, Iowa,  Maine,  Maryland,  Massachusetts,  Michigan,  Minnesota,  Montana, New Hampshire, New Jersey, New Mexico, New York, Oregon, Vermont, and Washington.
  • Nine states require all insurers on the individual market to cover maternity care. These states are California (as of July 1, 2012), Colorado, Massachusetts, Montana, New Jersey, New York, Oregon, Vermont and Washington. An additional three states, Alabama, Georgia, and Illinois, require at least some plans on the individual market to provide maternity coverage.
  • The Affordable Care Act applies nationally and eliminates gender rating in the individual market, requires all plans on the individual market to provide maternity coverage, and prohibits sex discrimination in health plans from insurance companies that receive federal funds or are conducted by the federal government.