Women and the Affordable Care Act: What You Need to Know

careact by Dr. Denice Logan

Health insurers must cover at least one preventive doctor appointment per year. Are you aware of healthcare details like this? If not, you’re not alone. Sixty percent of women don’t know about their free preventive visit, according to a survey from the Kaiser Family Foundation.

Women often wait until they’re sick or injured to take care of themselves, sometimes with tragic consequences. Many illnesses, like cervical cancer, do not have warning signs until the illness is serious and much more difficult to cure. By getting regular PAP smear screenings and pelvic exams, you can catch cervical cancer early, when it is nearly 100 percent treatable.

Under the Affordable Care Act (ACA), a lot of changes were made to ensure women have access to important preventive services.  All ACA-compliant plans, along with many other plans, must cover a specific list of services for women without charging copayment or coinsurance. This is true even if you haven’t met your yearly deductible.

Below are a few of the services provided for free under your health plan:

  • Breast cancer mammography screenings every 1 to 2 years for women over 40.
  • Breastfeeding comprehensive support and counseling from trained providers, and access to breastfeeding supplies for pregnant and nursing women.
  • Cervical cancer screening
  • Domestic and interpersonal violence screening and counseling for all women.
  • Tobacco use screening and interventions for all women and expanded counseling for pregnant tobacco users.
  • Well-woman visits to get recommended services for women under 65.

For a complete list of services, you can visit the healthcare.gov website.

In addition to routine services, all health plans must cover maternity services and newborn care and employers must provide time and space for breast-feeding. Women can no longer be denied coverage based on a pre-existing condition, and we cannot be charged more for insurance based on gender.

As long as the doctor is in-network and the visit is for preventive care, then you don’t have to worry about a co-pay, coinsurance or deductible. Keep in mind that out-of-pocket expenses may occur if:

  • A patient receives other services during the same visit that are not preventive
  • The services are used to treat, diagnose or monitor an illness, injury or health problem

When you first enroll in a plan, it can be overwhelming. To save you time and money in the long run, make sure you read through your documents to know what’s covered. All insurers are required to give you a document called a “summary of benefits and coverage.” If you don’t have it, most insurers have a copy online or can mail you one upon request. If you get coverage through your employer, the insurer works with your employer to provide these summaries.

If you want to continue to be there to care for your loved ones, you need to care for yourself. Make your health a priority. Schedule a doctor’s appointment today, and make sure you continue to receive regular preventive screenings. For more information on how to better understand and use your health insurance, visit bcbsm.com/101.


Five costs that make up your health plan

The easiest way to understand what you pay is to understand the terms your insurance company uses:

Premium: A premium is a fixed amount paid (typically monthly) to the insurance company for health coverage. Premiums vary based on what expenses are covered in a plan and which doctors are seen.

Copayment (or Copay): A fixed dollar amount (for example $15) paid by you at the time of a service, such as a doctor visit.

Deductible: A fixed dollar amount paid by you for medical services (as outlined in your plan) before your insurance company starts to pay.

  • A consumer pays 100 percent of the covered medical costs until the deductible amount is reached.
  • Preventive services (like your annual wellness visit) are covered by the health carrier and don’t count toward the deductible.

Coinsurance: A fixed percentage of the costs of the covered services that are shared with the insurance company after the deductible is met.

  • For example a 20/80 coinsurance means the consumer pays 20 percent of the costs and the insurance company picks up the remaining 80 percent.

Out-of-Pocket Maximum: This is the maximum dollar amount paid in deductibles, copayments and coinsurance during one
plan year.

  • Once the out-of-pocket maximum is hit, the health carrier will typically cover 100 percent of what is owed for covered services.

 

DeniceLogan

Dr. Denice Logan, DO, is a medical director at Blue Care Network of Michigan.

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