How does health insurance treat women?

Updated for 2013

Volume 113, No. 3March, 2013

Martha Hyde

For women, It is good to know what health programs you can take advantage of. In recognition of Women’s History Month, here is a brief tour of what women should know about health protections and the law.

The Newborns’ and Mothers’ Health Protection Act of 1996 requires health plans offering maternity benefits to pay for at least 48 hours in the hospital after a vaginal birth and 96 hours after a cesarean. Some of you may have noticed the Local 802 Health Plan has been sending notices of this coverage. More info at:

The Women’s Health and Cancer Rights Act of 1998 requires plans covering mastectomies to also cover all stages of reconstructive surgery and complications. The Local 802 plan has been sending out notices about this as well. More info at:

Medicare Part B (the health insurance program for age 65 and up) covers bone mass measurement every 24 months if you are in a risk category. Fragile, thin-walled bones are a serious health problem for many elderly women. More info at:

Medicare Part B also covers yearly PAP smears and pelvic exams as well as mammograms. Go to

Medicare is covering more preventive services in general as part of the Affordable Care Act. Traditional Medicare Part B used to only offer one physical exam to be used as a benchmark when a 65-year-old first enrolls. Now there is a whole new list of preventive services. See

Federal law gives uninsured women at or below 250 percent of federal poverty level access to screening and treatment of breast and cervical cancer. Go to

Pregnant women and children under 6 are eligible for Medicaid at 133 percent of federal poverty level. In some states the eligibility income level is higher. See

Older children up to age 19 can be covered under the Children’s Health Insurance Program (CHIP), if the annual income for a family of four is $44,100 or lower. In some states the income eligibility is higher. See

The Affordable Care Act had a provision to cover everyone at 138 percent of poverty level under Medicaid, regardless of gender or age. This was known as Medicaid expansion. States that refused to implement the expansion would have been subject to the loss of federal dollars for their Medicaid programs. This is the one provision of the law that was struck down by the Supreme Court in June 2012. This is causing a lot of confusion. New York claims to lean toward the expansion, though it may end up not looking exactly like what the law stipulates. New Jersey opted to expand eligibility to 70,000 single adults in the spring of 2011 under a section of the law; Governor Christie says he is unlikely to support expanding it further. Connecticut claims it will expand eligibility in accordance with the law.

New York, New Jersey and Connecticut cover eligible pregnant women through a 60-day postpartum period. For New York, see For New Jersey, see For Connecticut, see

For pregnant women meeting the income criteria, Medicaid law requires: nurse-midwife services; pregnancy-related services; services for conditions complicated by the pregnancy and family planning services and supplies. This last excludes abortion services in most states because of the Hyde Amendment (no relation to this author) of 1976, which forbids federal Medicaid funding of abortions except in cases of rape, incest, or if the pregnancy endangers the life of the woman. New York, New Jersey and Connecticut are three of 17 states using state funds to pay for abortions as other reproductive services are paid for.

In New York it is possible to buy low-cost coverage through Healthy NY. You must be employed but not eligible for health benefits, and you must meet income criteria. If you run a small business, it must have 50 or fewer employees. For more information go to There is an interactive tool on the site that can help you determine if you may be eligible.

There will soon be big changes to how New York addresses the needs of uninsured people as the Affordable Care Act rolls out. The state is planning to run a health insurance exchange where individuals and small businesses will be able to shop for insurance if they are without coverage. See my previous Allegro article here:

In New Jersey, Gov. Christie vetoed legislation setting up an exchange in the state, setting the stage for the federal government to do it. However, the Actors Fund is planning to partner with a Consumer Operated and Oriented Plan (CO-OP) in New Jersey. CO-OPs are part of the new health law. See

Connecticut is planning to run its own exchange; you can find information here:

In general, you can track the progress of the Affordable Care Act at and

The Local 802 Health Plan generally does not cover preventive care; however, it does pay for yearly PAP smears and pelvic exams for women 18 and older, mammograms every two years for those aged 40 to 50 and yearly for 50 and up. The Affordable Care Act requires plans to cover preventive services without co-pays. However, Local 802’s plan is “grandfathered” meaning it existed before the law was signed on March 23, 2010. Once the law fully rolls out in January 2014, there will be significant changes to the Local 802 plan. We do not know what those changes will be yet but making the changes will cause the plan to lose its “grandfather” status.

Until the health reform was signed in 2010, insurance companies were allowed to take gender into account when setting premium levels. Because of maternity costs and research that shows women are more likely than men to seek medical care, insurers set premium levels for women at 4 to 48 percent higher than for men. This practice, called “gender rating,” is no longer allowed in the individual or small group market but will still be permitted in some cases for plans covering 100 or more people. Eleven states ban this practice, including New York and New Jersey, but not Connecticut. The Local 802 health plan has never practiced “gender rating.” (Also, on a separate note, the Local 802 health plan treats domestic partners the same as spouses.)

Be well! And here are more recommended Web sites:

Martha Hyde is a multi-instrumentalist and Broadway musician. She serves on the union’s Executive Board and has served as a trustee on the union’s health fund since 1993. E-mail her at