New Rules Mandate Preventive Care for Women Without Copays
By Katharine Davis
In August, the US Department of Health and Human Services (HSS) brought access to preventive care one step closer to reality for low- and middle-income women. New guidelines from the agency mandate that as of August 1, 2012, all new health insurance plans must cover certain preventive services, including contraception, without requiring copayments, coinsurance, or deductibles.
To lower the burden of chronic diseases, which are currently responsible for 7 in 10 deaths among Americans, one of the goals of the Affordable Care and Patient Protection Act of 2010 was to make preventive care more accessible. When the Act was passed last year, it stipulated that recommended preventive screenings be covered by new health insurance plans at no additional cost to the plan holder. The list of covered services, based on recommendations from the US Preventive Services Task Force and the Centers for Disease Control, included mammograms and Pap smears but did not cover many of women’s other unique health-care needs. Recognizing this, lawmakers included in the Act a provision that empowered the HHS to approve additional covered services. The agency commissioned the Institute of Medicine (IOM), an independent panel of medical experts, to advise it on what should be covered.
After reviewing the scientific evidence for a variety of preventive services, the IOM released its report in July of this year. On August 1, the HHS announced its approval of the recommendations.
As of August 2012, health insurance plans must cover the following services without cost sharing:
- All Food and Drug Administration-approved contraceptive methods and counseling, including birth control pills, intrauterine devices (IUDs), and diaphragms
- Annual well-woman visits, including recommended screenings and preconception and
- prenatal care
- Screening for gestational diabetes in pregnant women
- Breast-feeding counseling and equipment
- High-risk DNA testing for human papillomavirus (HPV), a common cause of cervical cancer, every three years
- Annual counseling for sexually transmitted infections
- Annual screening and counseling for interpersonal and domestic violence
Calling the new guidelines “a historic step toward addressing women’s unique health care needs,” NOW-NYC Deputy Director Jean Bucaria said they are a win for women because they “expand women’s access to preventive care, make contraception affordable with insurance, and recognize antiviolence measures as a critical part of women’s health.”
Research has shown that even modest cost sharing deters many women from receiving the preventive services they need. In a 2009 survey, the Guttmacher Institute found that 30% of women who were financially worse off because of the recession had put off a family planning visit to save money. By removing cost barriers, the changes have the potential to significantly improve women’s health.
NOW-NYC, alongside other women’s advocacy organizations, had been focused on securing expanded coverage for contraception. NOW-NYC Executive Director Sonia Ossorio said, “You’d think that expanding coverage for birth control would be straightforward, but it wasn’t. We needed more studies, more experts, more comment periods, more voices-all to support what has been obvious to women and the medical community for years.”
The new rules have two important caveats. First, they allow the HHS to grant religious employers an exemption to the requirement about contraception coverage. Because such exemptions would be at the department’s discretion, it is unclear how many women would remain without access as a result.
Second, the rules do not apply to plans that are considered “grandfathered” under the Affordable Care Act. A grandfathered plan is one that existed before March 23, 2010, and that has not made significant cuts to existing benefits or increased beneficiaries’ out-of-pocket spending. You can ask your employer whether your plan has grandfathered status.
The new rules issued by the HHS are so-called “interim final rules,” meaning the agency is putting them into effect but simultaneously leaving them open for comment. They have the potential to be revised in the future. NOW-NYC is calling on individuals to submit comments in support of the rules.