How does health insurance treat women?
Volume 112, No. 3March, 2012
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: http://1.usa.gov/Note01
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: http://1.usa.gov/Note02
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: http://1.usa.gov/Note03
Medicare Part B also covers yearly PAP smears and pelvic exams mammograms. Go to http://1.usa.gov/Note04
Medicare is covering more preventive services in general as part of the new federal health reform. 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 http://1.usa.gov/Note05
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 http://1.usa.gov/Note06
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 http://go.cms.gov/Note07
New York, New Jersey and Connecticut cover eligible pregnant women through a 60-day postpartum period. For New York, see http://bit.ly/Note08. For New Jersey, see http://bit.ly/Note09. For Connecticut, see http://1.usa.gov/Note10
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 http://bit.ly/Note11. 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 federal health law rolls out. You can track the progress at www.HealthCareReform.ny.gov and www.HealthCare.gov.
The Local 802 Health Plan generally does not cover preventive care; however, it does pay for yearly PAP smears and pelvic exams for age 18 and up, mammograms every two years for those aged 40 to 50 and yearly for 50 and up. The health care reform law 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, the grandfathering will no longer apply.
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:
U.S. Department of Labor (www.dol.gov)
National Women’s Health Report (www.HealthyWomen.org)
National Women’s Law Center, (www.nwlc.org)
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 Earmar4@verizon.net