As women’s week of action begins this Sunday, December 8th and runs through the final day of the Health Insurance Marketplace open enrollment on Sunday, December 15th, we want to remind you to shop smart and get covered.
The annual opportunity to enroll in comprehensive coverage gives women and families guaranteed access to health insurance. Thanks to the Affordable Care Act (ACA), coverage cannot cost more or cover less based on a preexisting condition, gender or most other factors that health insurers routinely used pre-ACA to screen out people they didn’t want to cover. Unfortunately, Trump Administration actions to undermine the ACA has allowed health plans that use all the old industry tactics to discriminate and dodge costly health claims to expand. This means women shopping for themselves and their families must look for the fine print to know that they’re getting a plan that will provide comprehensive coverage and adequate financial protection.
What you can expect with an ACA plan
ACA plans must cover – without dollar limits – a comprehensive set of benefits known as Essential Health Benefits, including maternity care, prescription drugs, mental health and substance use disorder services. Preventive services must be covered without cost-sharing, including contraception, well-woman visits, breast and cervical cancer screening, and many prenatal services. And insurers can’t set premiums based on gender or health status. That’s critical for the 68 million women and girls with a preexisting condition and the nearly 6 million pregnancies each year. Those with moderate or low income can also get financial help for premiums and out-of-pocket costs if they purchase a plan through the marketplace.
Beware of junk plans
It may be tempting to look at other plans, particularly if you don’t qualify for financial help, but other coverage options have lower monthly premiums because they cover less. Aggressive marketing,look-alike websites and bundled packages of many different policies that purport to provide comprehensive coverage are competing for your shopping attention – and dollars – this open enrollment. Keep in mind, though, that non-ACA plans don’t come with minimum coverage requirements or protection against discrimination based on gender or pre-existing conditions, like a diagnosis of HIV or AIDS, lupus, or an eating disorder, among other conditions, or even pregnancy and caesarian birth. Short-term plans also typically don’t offer coverage for maternity care, prescription drugs and mental health and substance use disorder services.Health care sharing ministries also promise lower monthly costs and look a lot like insurance, but they don’t cover preexisting conditions or many key services, and will never guarantee payment for members’ claims.
How to be a smart shopper
Start by going to Healthcare.gov. There you can find in-person assistance, get screened for financial help and view available plans. If you live in a state that runs its own marketplace, healthcare.gov will route you to the website for your state. If you are eligible for subsidies, your best bet is likely to buy a plan in the marketplace, particularly if you also qualify for help with out-of-pocket costs. In fact, 9 in 10 people qualify for financial help to make their monthly premiums more affordable. Last year, most people found plans available between $50 to $100 per month, and some are able to qualify for a plan for $10 or less. You aren’t likely to find a better deal with a plan sold outside the marketplace.
If you don’t qualify for financial help, there may also be ACA compliant plans available outside the marketplace, but you’ll need to be really careful that you don’t end up in a plan that promises more than it delivers. Here are some ways to be a smart shopper:
- Ask any sales rep for the Summary of Benefits and Coverage (or SBC; it should look like this). If the plan doesn’t have an SBC but only has a brochure or simple benefit summary, then it’s not comprehensive coverage.
- If the insurer or broker asks you about your health history or if you take medication, it’s probably not an ACA plan.
- Never pay for a plan without seeing benefit information in writing first. Key information about plan limits may be withheld from you until it’s too late. Don’t just trust a person who calls you and tells you the plan meets your needs.
Also, keep in mind that mid-year changes in your circumstances may qualify you for a special enrollment period to enroll in an ACA plan outside of open enrollment. Examples include losing qualifying coverage by, for example, aging off a parent’s plan or losing a job-based plan, birth of a child, or experiencing a change in income that may make you newly eligible for subsidies.
Finally, without comprehensive health insurance, a single accident or illness could threaten you and your family’s health and financial security. Only 1 in 20 uninsured consumers know about the December 15th deadline, so spread the word to everyone you know.
Young or old, everyone needs health insurance. Sign up for coverage at Healthcare.gov.