What Women Should Know About the Affordable Care Act
The Affordable Care Act (ACA) completes its multi-phase roll out on October 1, 2013. And promises to be packed with plenty of benefits specifically for women.
But a new survey conducted by Lippe Taylor/SheSpeaks reveals that 50 percent of women believe that the Affordable Care Act (nicknamed “Obamacare”) is confusing, with only 22 percent believing it will benefit their families. And only 28 percent believe it will be positive.
Experts admit the ins and outs of the ACA can seem daunting. But don’t worry; we’ve got you covered! Here’s how a woman can navigate the ACA and ensure she has the best healthcare to suit her needs.
Sizing up women-oriented services
“Most health plans must cover a host of services for women without charging a copayment or coinsurance, even if you haven’t met your yearly deductible,” says. Dyana Tanasy, director, Strategic Innovations for Horizon Blue Cross Blue Shield of New Jersey. “You can’t be denied coverage or charged more due to pre-existing conditions, like cancer or being pregnant, and you will be able to choose from any primary care provider, OB-GYN or pediatrician in your health plan’s network without a referral.”
Tanasy says other benefits include annual well-woman visits for women age 18-64 and domestic violence screening and counseling. It also includes immunizations like the HPV vaccine for women age 19-26 (HPV has been tied to cervical cancer), and coverage at no out-of-pocket cost for various preventive screenings, such as mammography every 1 to 2 years for women age 40+, Genetic BRCA screening and counseling (based on risk factors), and pap testing.
Other services include:
- Breast cancer chemoprevention counseling for women at high risk
- Breastfeeding comprehensive support and counseling from trained providers as well as access to breastfeeding supplies for pregnant and nursing women
- Food and Drug Administration-approved contraceptive methods, sterilization procedures and patient education and counseling, as prescribed by a health care provider for women with reproductive capacity (not including abortifacient drugs). This does not apply to health plans sponsored by exempt religious employers.
- Folic acid supplements, urinary tract or other infection, gestational diabetes, anemia, Rh incompatibility and Hepatitis B screenings for pregnant women.
- Osteoporosis screening for women over age 60 depending on risk factors
- HIV and other sexually transmitted infections screening and counseling for sexually active women
- Tobacco use screening and interventions for all women, and expanded counseling for pregnant tobacco users
Expect less from your doctor
Despite the added and expanded coverage, healthcare professionals caution there are some drawbacks.
Marcela Dominguez, M.D., a board-certified primary care physician in Southern California with a specialty in women’s health and integrative medicine says women will find that their internist, pediatrician or GP at their HMO or PPO will be “less available” once Obamacare kicks in.
“The 33 million previously uninsured Americans entering the system will exacerbate an already dire doctor shortage in the U.S.,” says Dominguez. “Experts say we will be short 65,000 physician M.D.s by the end of next year, and the shortage is especially acute among primary care doctors.”
This is further compounded by a graying population that requires more healthcare per capita (nearly 10,000 Baby Boomers are enrolling in Medicare every day) and a rash of medical school students studying lucrative specialties instead of primary care practice.
“All of that adds up to diminished doctor facetime,” says Dominguez. The math doesn’t lie. In the future, during your next doctor visit you’re likely to be seen by a nurse practitioner or physician assistant rather than by a physician M.D.”
Make the most of coverage
These strategies will help you combat office visit overload at your doctor’s office and maximize the benefits offered via the Affordable Care Act:
Don’t assume. When considering different health insurance options, make sure that any new plan is accepted by your preferred doctors or clinics, says Kristen Stoll, consumer specialist at eHealthInsurance. “You can also request a copy of the Summary of Benefits and Coverage form for each plan which describes what you can expect to pay out of pocket for a number of specific medical services, including prescription and pregnancy and delivery.”
Count pennies. “Keep in mind the lower the premium, the higher the out-of-pocket costs when you need care,” says Stoll. On the flip side, the higher the premium, the lower the out-of-pocket costs when you need care.
Book an appointment with your doctor now. If you’ve been putting off a woman’s well exam, an influx of newly insured patients in early 2014 will likely mean competition to see your doctor.
Stay informed. Think about how much you will use your benefits, and make the right tradeoff between premiums and cost sharing, says Stoll.
Get a copy of your health record. An electronic copy of your health records through resources like Patient Fusion, especially if you’re newly insured and seeing new doctors, will mean that your doctors can more easily coordinate care and you can keep tabs on your health.
Explore subsidies. Those earning between 133 to 400 percent of the Federal Poverty Level may be eligible for discounts and subsidies to offset the cost of healthcare. You can enroll in subsidy-eligible health insurance plans through your state exchange or a private licensed online marketplaces authorized by the state exchange.
“If you don’t qualify for subsidies, don’t limit yourself to shopping through the state exchange,” says Stoll. Exchanges offer only subsidy-eligible plans, which comprise a subset of all the plans available in your area. A licensed health insurance agent or online marketplace can introduce you to a broader range of coverage options and provide you with personalized advice.