Affordable Care Act

All women in the United States will soon have access to health insurance regardless of their employment status, financial status, or whether they have pre-existing conditions. 

As part of the Affordable Care Act, health care insurance will soon be required for nearly everyone in the United States. On October 1, open enrollment begins at the Health Insurance Marketplace, (sometimes referred to as the “exchange”), a place to help consumers find health coverage choices that fit their budgets and needs. Coverage begins as early as January 1, 2014. 

Under the new coverage rules, more emphasis is placed on wellness and preventive care. Pregnant women and those planning to become pregnant will have access to more information and services regarding pregnancy. Since studies have shown that breast feeding reduces respiratory ailments and obesity in children and the rate of Type 2 Diabetes in moms, more services will be available to encourage the practice. The law requires health insurance to cover the cost of lactation support and equipment, and requires employers to provide ample break time and a private location – not a bathroom  – in which to breastfeed or pump, according to Dr. Nancy Lee, Director of the Office on Women's Health in the Office of the Secretary, U.S. Department of Health and Human Services. 

The changes are especially good news for younger women, but all women will benefit. No longer can women be denied coverage or can insurance cost more based solely on gender. In the past, “women could be denied coverage just because we are women,” explained Kathleen Sebelius, U.S. Secretary of Health and Human Services.

Birth-control methods are fully covered, but abortion services are not required to be covered. For example, all Food and Drug Administration-approved contraceptive methods prescribed by a woman’s doctor are covered, including birth-control pills, diaphragms, IUDs and the so-called morning after pill. Sterilization procedures are also covered. However, plans are not required to cover abortion drugs or male vasectomies.

Other important changes include: Women and men formerly in the grey zone between the ages of 19 and 25 are now eligible for coverage under their parent’s insurance plans. And, pre-existing conditions are no longer a barrier to coverage and plans can’t charge more for your pre-existing condition like pregnancies or cancers.

While all insurance plans are offered by private companies, the Marketplace is run by either your state or the federal government. Regardless of the political environment in your state – say, your state’s governor doesn’t agree with “Obamacare” – the Health Insurance Marketplace will operate in all states. According to its website, www.healthcare.gov, whether you’re uninsured, you’ve been denied coverage in the past, or you are interested in the possibility of reducing your costs, the Health Insurance Marketplace will give you more choice and control over your health coverage. 

At www.healthcare.gov, consumers can compare coverage options based on price, benefits, quality, and other features. Consumers can choose the combination of price and benefits that fits their budget and needs. Consumers can apply for coverage online, by mail, or in-person. Open enrollment starts October 1, and plans and prices will be available then at www.healthcare.gov. 

Insurance plans are offered by private companies, and they cover a core set of benefits including outpatient care, emergency services, hospitalization, maternity and newborn care and prescription drugs. Other required services include mental health and substance use disorder services, including behavioral health treatment services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills, laboratory services, preventive care and chronic disease management, and pediatric care. 

If someone can afford it but doesn't have health insurance coverage in 2014, they may have to pay a fee – and the entire cost of any medical care they need. The fee in 2014 is 1 percent of annual income or $95 per person for the year, whichever is higher. The fee increases every year. In 2016 it will be 2.5 percent of income or $695 per person, whichever is higher. In 2014 the fee for uninsured children is $47.50 per child. The most a family would have to pay in 2014 is $285. In some cases, the fee is waived. For more information on the fees for the uninsured and other information about the available plans, go to www.healthcare.org.