Though health care is changing rapidly, the ACA is still the way for the time being. Do you know which women’s health services are covered in your plan? Family planning and birth control in 2017 is a required benefit with Marketplace plans, Medicaid, and Medicare. Are you taking advantage of the services that are available to you?
Within the Affordable Care Act Marketplace, every plan is required to cover contraception and counseling without co-payments or coinsurance (even if you haven’t met your deductible). Plans are not required to cover sterilization procedures and abortions. There are exceptions – religious employers, for example, are not required to provide contraception-friendly health plans (in the name of religious freedom). In those cases, you can find a third-party health plan administrator to provide contraceptive coverage.
Marketplace plans are also required to provide breast feeding support benefits, breast pumps, and counseling as well as mental health services including those to treat post-partum depression and substance abuse.
In 2011, there were 19.4 million female Medicaid beneficiaries, and we know that number has only risen. Of those women, about 70% were of a reproductive age. The Medicaid program is the largest source of funding for women’s health and family planning services. States have been required to provide family planning through Medicaid for decades, but the Affordable Care Act brought some changes. For instance, even though family planning coverage is required, states can dictate which family planning services are covered (i.e. abortions). Coverage almost always includes contraception, STI/STD testing and treatment, fertility preservation, and sterilization.
Medicaid beneficiaries are not limited to a network of doctors and pharmacies – they can achieve service with any provider that participates in Medicaid. The federal government matches those services at 90%, which is more than any other type of service. Matching at 90% is expensive, which means Medicaid has to have strict limitations. Unfortunately, that means those who are just slightly ineligible for Medicaid and truly need the help can’t have it. To help with that problem, the federal government allows states to use waivers which basically pull from “leftover” Medicaid funding to help women who recently had a change in income which left them ineligible for Medicaid but still in need of assistance. The ACA allows states to file an SPA (State Plan Amendment) without federal permission to use those waivers.
Though nothing is set in stone yet, Medicaid may lose funding if the Senate votes to “repeal and replace Obamacare,” and some of this may once again change.
Women who are beyond their reproductive age and have a Medicare plan are eligible for women’s health benefits that are largely the same as they would have been with their previous plan. Senior women can visit any OB/GYN office that accepts Medicare. Their coverage falls under Medicare Part B and includes preventative care (STI/STD screenings, counseling, well-visits, Pap tests, pelvic exams, etc.) and treatments. It is extremely important that senior women seek an OB/GYN for yearly breast exams and mammograms as cancer risk increases with age.
If you need help finding a Marketplace plan in Tennessee, call HealthTN today at 615-541-5250.