The State of Health Insurance for Women

What the health insurance system is like now, plus tips on navigating it

Pregnant woman at a doctor's appointment, representing women's healthcare needs
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There are some things women are better at than men. Taking care of their health isn’t one of them. According to a 2015 study from ZocDoc, a digital health marketplace, when they’re sick, two-thirds of women would rather wait it out than make a doctor’s appointment right away (only half of the men surveyed said the same). More troublingly, women are more likely than men to put off preventive care.

The health insurance landscape has changed considerably in recent years. The Affordable Care Act (ACA), introduced in 2010, created a standard scope of coverage for major medical health insurance plans, including coverages and services specific to women. Here we take a closer look at the health insurance plans available for women and what services women can count on.

Women’s Health Care Today

Sixty-one percent of women’s health insurance coverage is through employer-sponsored plans. Another 17% receive coverage through Medicaid, while just 8% buy a health insurance policy directly. Still, a full 11% (11.1 million) of women ages 19 to 64 are uninsured.

Uninsured women have inadequate access to care and poorer health outcomes than those who are insured. This could be because uninsured women can’t take advantage of essential preventive services, like Pap tests and mammograms. 

Lack of health insurance coverage is also concerning, since over 15% of women aged 18 and over are in fair or poor health. And more than 45% of women 20 and older have high blood pressure.

What Health Insurance Plans for Women Cover

Exact health insurance plan coverages for women vary based on the type of plan. Here’s a look at the most common types.

Health Insurance Marketplace

The Health Insurance Marketplace, or simply “the Marketplace,” was created by the Affordable Care Act. While specific plans vary, all Marketplace plans must cover the following 10 essential health benefits:

  • Outpatient care services
  • Emergency services
  • Hospitalization
  • Pregnancy, maternity, and newborn care
  • Mental health and substance abuse disorder services
  • Prescription drugs
  • Rehabilitative and habilitative services and devices
  • Laboratory services
  • Preventive and wellness services and chronic disease management
  • Pediatric services and oral and vision care for children

Plans must also include birth control and breastfeeding coverage. Numerous preventive screenings and services for women are also free, including:

  • Breastfeeding comprehensive support and counseling
  • Gestational diabetes screening
  • Urinary tract or other infection screening
  • Breast cancer genetic test counseling (BRCA) for women at higher risk
  • Breast cancer mammography screenings for women over 40

While insurers must cover essential health benefits, you’ll likely still have deductibles, copayments, and other costs to pay. 

Private Plans

In addition to providing the 10 essential health benefits, all major medical private health insurance plans outside the Marketplace must include maternity care coverage. Most must also have preventive services coverage without copayments or cost sharing. Coverage includes:

  • Prenatal visits
  • Well-woman visits
  • Breast and cervical cancer screening
  • Breastfeeding supplies
  • Prescribed contraceptives
  • Several STI services 

When looking outside the Marketplace, there are also short-term medical insurance plans, fixed-dollar indemnity plans, critical-illness policies, and more that aren’t required to be ACA compliant. 

Medicaid

Each state uses current federal guidelines to determine various aspects of its Medicaid program, including services provided and durations. That said, federal law requires states to provide Medicaid benefits like: 

  • Inpatient and outpatient services
  • Physician services
  • Laboratory and x-ray services
  • Home health services
  • Family planning services
  • Nurse midwife services
  • Certified pediatric and family nurse practitioner services
  • Freestanding birth center services
  • Transportation to medical care

Services like prescription drugs, physical therapy, chiropractic care, and occupational therapy are optional. 

Many women use Medicaid for various reproductive health services, including family planning and pregnancy-related services, with coverage continuing up to 60 days postpartum. Medicaid is also popular for mental health services, preventive services and treatments for breast and cervical cancer, and financing care for women with physical and mental disabilities.

Tips for Improving Health

According to the CDC and the Census Bureau, the top five leading causes of death for women (heart disease, cancer, stroke, chronic lower respiratory disease, and Alzheimer’s) are often preventable. Here are a few tips to improve your health and decrease your health risks. 

Pick Your Best Health Insurance Option

Improving your health starts with picking the right health insurance coverage for the treatments and preventive services you need.

  • The Health Insurance Marketplace: Marketplace health plans are often the most affordable because of subsidies, premium tax credits, and cost-sharing reductions. It’s worth determining your eligibility for health insurance. Enrollment is open through August 15, 2021, because of the pandemic, but you can also enroll during Open Enrollment or a Special Enrollment Period. 
  • Medicaid: Your state’s Medicaid program is also worth seeing if income qualifies you for free or low-cost health coverage. You can apply for Medicaid through the Health Insurance Marketplace automatically when you submit a Marketplace application. If it looks like you may qualify for Medicaid, your state agency will contact you about enrollment.
  • Private Health Insurance: Private health insurance can be a good alternative when you don’t qualify for Marketplace subsidies, are outside of the Open Enrollment or Special Enrollment periods, or aren’t eligible for Medicaid. Contact your state’s Department of Insurance for a list of reputable brokers who can assist with finding plans that meet ACA standards.

A plan’s Summary of Benefits and Coverage clearly lists costs, coverages, and benefits associated with a plan, making it easier to comparison shop on your own. If a private insurer can’t provide you with one, it may mean there are coverage limitations. 

Follow Screening Recommendations and Care for Chronic Conditions

The latest data from the Kaiser Family Foundation shows that nearly a quarter of women delayed or didn’t receive care in the last 12 months because they couldn’t find time to go to the doctor. Another 23% couldn’t take time off work.

While it can seem almost impossible to budget the time for a doctor’s appointment, following preventive screening schedules and managing chronic conditions is crucial for maintaining your health. 

There are general screening schedules for women up to age 64, but your doctor can provide specific advice based on your risks. Your doctor can also give guidance on treating your health conditions, such as diabetes, high cholesterol, or blood pressure. 

Practice Healthy Lifestyle Habits

Family history is a risk factor for certain conditions, but healthy lifestyle habits can go a long way in controlling the other risk factors for diseases. Some of the most important ones include: 

  • Following USDA dietary guidelines
  • Maintaining a normal Body Mass Index (BMI) for your height and weight
  • Getting at least 150 minutes per week of moderate-intensity aerobic activity and completing a muscle-strengthening activity at least two days per week
  • Not smoking and avoiding exposure to secondhand smoke and other air pollutants
  • Limiting alcohol consumption to one drink or less per day
  • Managing stress by addressing causes, building strong relationships, resting your mind, and getting help from licensed mental health professionals as needed