Managing Your Practice

Women’s health under the Affordable Care Act: What is covered?

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Women stand to make considerable gains under health reform, starting with guaranteed access to preventive services without cost-sharing


 

For the first half of 2012, the big question was: Will anything be covered under the Affordable Care Act (ACA)? After considering constitutional challenges to the Act that had the potential to invalidate the entire law, the US Supreme Court ruled, on June 28, that the ACA met constitutional muster in National Federation of Independent Business v. Sebelius (2012).

Now that the Court has upheld the ACA, let’s review the major women’s health services included under the law. This Web version incorporates 10 more women's health provisions from the ACA, from smoking cessation to young women’s breast cancer, that were not in the print version.


Preventive services guaranteed without copays

A major component of the health reform law went into effect August 1, 2012; it requires most health plans to cover women’s preventive services without requiring enrollees to pay a copay or deductibles. This provision reflects Congress’ understanding that women have a longer life expectancy and bear a greater burden of chronic disease, disability, and reproductive and gender-specific conditions. In addition, women often have a different response to treatment than men do.

The federal Department of Health and Human Services (HHS) estimates that Americans use preventive services at only about half of the recommended rate. By 2013, as many as 73 million individuals will benefit from preventive care offered under the law.

The American Congress of Obstetricians and Gynecologists (ACOG) worked with the Institute of Medicine (IOM)—which was charged with advising HHS—to encourage the inclusion of women’s preventive services specified in ACOG guidelines to ensure women’s health and well-being. As ACOG Executive Vice President Hal C. Lawrence, MD, told the IOM in January 2011:

  • The College’s clinical guidelines…offer an excellent resource…and encompass the entire field of women’s preventive care. Our guidance is based on the best available evidence and is developed by committees with expertise reflecting the breadth of women’s health care and subject to a rigorous conflict of interest policy.

Dr. Lawrence further urged the IOM “to recommend coverage of the following services and products without cost-sharing”:

  • well-woman visits
  • preconception care
  • family planning counseling and services
  • HIV screening (for women at average risk)
  • screening for intimate partner violence
  • testing for human papillomavirus (HPV) as part of cervical cancer screening.

ACOG’s recommendations were approved by the IOM and, subsequently, by HHS. As a result, all private health plans that began on or after September 30, 2010, are required to cover these services at no out-of-pocket cost to patients (TABLE).

Women’s preventive services guaranteed under ACA*

ServiceFrequencyHHS guidelines for health insurance coverage
Well-woman visitAnnual for adult women, although HHS recognizes that several visits may be needed to obtain all necessary recommended preventive services, depending on a woman’s health status, health needs, and other risk factors**The visit should focus on preventive services that are appropriate for the patient’s age and development, including preconception and prenatal care. This visit should, where appropriate, include other preventive services listed in this set of guidelines, as well as others referenced in section 2713
Screening for gestational diabetesBetween 24 and 28 weeks of gestation and at the first prenatal visit for pregnant women identified to be at high risk for diabetes
Testing for human papillomavirus (HPV)At age 30 and older, no more frequently than every 3 yearsHigh-risk HPV DNA testing in women who have normal cervical cytology
Counseling about sexually transmitted infection (STI)AnnualAll sexually active women
Counseling about and screening for HIVAnnualAll sexually active women
Counseling about and provision of contraceptionAs prescribedAll FDA-approved contraceptive methods and sterilization procedures. Counseling for all women with reproductive capacity
Breastfeeding support, supplies, and counselingIn conjunction with each birthComprehensive lactation support and counseling by a trained provider during pregnancy or postpartum (or both), as well as costs for renting breastfeeding equipment
Screening for and counseling about interpersonal and domestic violenceAnnual
HHS = Health and Human Services
* HHS guidelines are effective August 1, 2011. Nongrandfathered plans and insurers are required to provide coverage without cost-sharing consistent with HHS guidelines in the first plan year (in the individual market, policy year) that begins on or after August 1, 2012.
** The July 2011 Institute of Medicine report titled “Clinical preventive services for women: closing the gap” lists recommendations on individual preventive services that may be obtained during a well-woman preventive service visit.
Group health plans sponsored by certain religious employers, and group health insurance coverage in connection with such plans, are exempt from the requirement to cover contraceptive services.
SOURCE: Adapted from Healthcare.gov. Affordable Care Act Expands Prevention Coverage for Women’s Health and Well-Being. http://www.hrsa.gov/womensguidelines/. Accessed August 8, 2012.

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