Health Insurance

A study published in the journal Women’s Health Issues last week highlighted a problem many women have confronted over the years when getting their birth control: even when you have insurance, the costs for contraception can be unaffordable. The study showed that, in 2010, on average women with private insurance paid $10 for a one-month supply of generic pills, $112 for an IUD, and $116 for an implant. The study also found that costs varied depending on your insurer, with some women having to pay more than $17 a month for generic pills, $305 for an IUD, or $308 for an implant. On top of these high costs, the study found that between 2007 and 2010, insurance companies shifted to women costs for long-acting contraceptives, like IUDs and implants. In 2007, a woman paid 13.8% of the cost of an IUD, whereas in 2010 she paid 17.5%.

If these price tags have you confused, there is hope. As I’ve mentioned on this blog before, the Affordable Care Act, often referred to as “Obamacare,” contains a provision that requires health insurers to provide coverage of the full-range of FDA-approved contraceptives without cost sharing. Read more »

Oh no he didn’t! Virginia Governor McDonnell Monday night added a ban on insurance coverage of abortion to a health care bill passed by the Virginia legislature. The underlying bill was meant to bring the state into compliance with the federal health care law – in other words, to help ensure affordable and comprehensive coverage for people, not take benefits away. But that’s exactly what Governor McDonnell’s amendment would do. And he’s not the only one.

Abortion insurance coverage bans have been introduced so far this year in at least 10 states. Some of these states are already among the 21 states that have such bans. But this year abortion opponents in those states want to prohibit even more women from obtaining abortion insurance coverage. Like Alabama, where a bill has been introduced to expand their exchange ban to all private plans and to take coverage away from survivors of rape and incest. Read more »

This weekend, the Washington Post published an article describing how the breast pump industry is faring now that the health care law requires health insurance coverage of such pumps. The article quoted our very own Judy Waxman and yours truly. As expected, there were many comments from readers vehemently disagreeing with the premise of covering breast pumps. The gist of the complaint is: “why should I pay for other peoples’ breast pumps. Why do women get these things for free?”

My initial response to these complaints is – as I have explained time and again – women are not getting their birth control or pumps for “free.” They are paying for it when they pay for health insurance, either by working for it and having it included as part of the employee’s benefit package (and likely still paying part of the premium) or by paying for it directly on the individual market. So this stuff isn’t “free,” the woman IS paying for it. Do you call the preventive care visits that now don’t have a no co-pay as “free?” No, it is not free. You pay premiums to your health insurance company so that they cover these medical care costs when you need such care. Read more »

Have you ever tried to compare health plans? It isn’t easy. Insurance companies design brochures to sell their plans. They have pictures of people holding hands, pushing a child on a swing, smiling in the doctor’s office and just being happy. They highlight everything that is great about the plan and, by the time you get to the chart summarizing the benefits, you would think this is the best insurance plan ever.

Then you look at another plan’s brochure that also makes the plan seem like the best insurance plan ever. But you try to compare the benefits and you aren’t really sure what you are comparing. The brochures use different terms and different formats. You can’t find a description of maternity coverage. You are trying to figure out how all the dollars and percentages add up to actual costs.

Starting today, things are different. That is because plans now have to provide all applicants and enrollees a standard Summary of Benefits and Coverage (called the SBC for short) and a uniform glossary. The Summary is simple to read, short, and provides a standard chart of benefits and coverage examples that every plan must use. The Glossary provides standard definitions of important health insurance terms that impact your coverage. Read more »

There’s a new rule in the health care law that holds insurance companies accountable for how they’re spending your premium dollars, ensuring that you get a certain level of value. Already, millions of people have benefited. This week, the powerful Energy and Commerce Committee is debating a bill that would largely gut this rule. While all consumers could lose out on some serious cash, this legislation would be especially harmful to women.

First let’s cover the basics. This new rule is called the “Medical Loss Ratio,” also referred to as the 80/20 rule, and it requires insurance companies to spend at least 80 percent (85 percent for large group plans) of your premium dollars on actual health care and quality improvement activities. Simply stated, this rule ensures that you get your money’s worth out of health insurance. Insurance companies can spend no more than 20 percent of your premium dollars on administrative expenses like salaries and marketing. If insurance companies fail to comply, you get refunded the difference. This rule is keeping insurance companies in check and putting money back in your pockets.

• $1.1 billion have been refunded as a result of the 80/20 rule.
• 13 million of you have received a rebate from your health insurance.

The Energy and Commerce committee is debating a bill (H.R. 1206) that would exclude the money that insurance companies spend on agents and brokers from this 80/20 calculation. In other words, any money spent on agents or brokers wouldn’t count toward the 20 percent limit on administrative expenses—essentially creating a loophole for this type of administrative spending. Read more »

Yesterday, the Census released 2011 data on health care coverage in the United States. The data reveals some encouraging news: In 2011, we saw positive trends in health coverage for the first time since 2007. Some 1.3 million more people had health insurance compared to 2010, and the overall proportion of those without coverage fell to 15.7 percent, down from 16.3 percent in 2010.

Women also fared better in 2011. The data shows that overall, more women had health coverage:

• An additional 219,000 women had health coverage in 2011, with the percentage of uninsured women (18 to 64) declining slightly from 19.9 percent in 2010 to 19.6 percent in 2011.
• An additional 760,000 women had Medicaid coverage in 2011, with the percentage of women covered through Medicaid rising to 12.3 percent from 11.6 percent in 2010.

Tomorrow, the Census Bureau will release new data on poverty, income, and health insurance in the U.S. in 2011. As we get ready to crunch numbers, we thought it would be helpful to take a deeper look at what these numbers will tell us about health insurance.

Where does this data come from?

Every month, the Census Bureau surveys approximately 50,000 households to estimate the unemployment rate. This is known as the Current Population Survey (CPS). Once a year, they supplement these questions with additional questions regarding health coverage and income and survey 78,000 households. This supplement is known as the Annual Social and Economic Supplement (ASEC). The ASEC questions regarding health insurance explore whether each member of the respondent household had insurance coverage throughout the previous calendar year, and if so, what kind of coverage.

There is some lag time between when the data are collected and when they are released. The survey is conducted in March and asks respondents about their insurance coverage over the entire previous year. It then takes several months for the data to be cleaned up and ready to release to the public in September. This means that the data released on Wednesday were collected in March of 2012 and will show insurance coverage at some point during 2011. According to the Census Bureau, the ASEC is the most widely used source of data on health insurance coverage in the U.S.

Many American Olympic athletes, despite being in incredible physical shape, face a tough time navigating the health care system and acquiring comprehensive coverage, just like us mere mortals.

Some Olympic athletes get their health care coverage through a Blue Cross Blue Shield program called the Elite Athletes Health Insurance (EAHI) plan. This plan covers the basics like preventive care and doctor’s visits, but of all things vital to elite athletes, it doesn’t cover sports injuries.

Given their high risk of injury and the EAHI’s high deductible, nearly all Olympic athletes have to buy a secondary plan that covers catastrophic injuries.  Not only do these athletes have to make sense of the different options and benefits, but out-of-pocket costs are based on their sport and level of competition. Athletes with less experience often face higher deductibles.

The EAHI doesn’t even cover all athletes. Each sport gets an allotted number of slots so those who don’t make the cut have to find coverage elsewhere. Athletes who don’t make the Olympic team usually won’t have access to EAHI and aren’t likely to have employer-based coverage.

American swimmer Dana Vollmer is exactly the type of athlete who could fall between the cracks in this broken system. At age 15, Vollmer was diagnosed with a potentially fatal heart problem known as Long QT syndrome. In order for her to keep competing, Dana’s mother had to bring an external defibrillator to Dana’s meets in case her heart stopped beating. Read more »

Remember when I told you about a great provision in the health care law requiring health insurance companies to spend your premium dollars on health care and not administrative costs or profits? My last blog post explains the whole deal.

An estimated 12 million Americans will receive rebates from health insurers totaling over $1 billion. And guess what? I got one! Well, sort of.

My health insurance company is CareFirst BlueChoice; it is the plan I receive as an employee of the National Women’s Law Center. A few weeks ago, I received a notice in the mail that CareFirst did not spend the legally required amount of premium dollars on care.

Check out the notice here. The accompanying letter says, “This letter is to inform you that CareFirst BlueChoice, Inc. will be rebating a portion of your health insurance premiums. This rebate is required by the Affordable Care Act—the health reform law.” [Some lovingly call it ObamaCare] If a health plan spends too much on administrative costs, as CareFirst did, it has to pay a rebate. Maybe next year they will get their act together and just charge lower premiums, which would be good too. Read more »

It’s Women’s Health Week. Time to Celebrate! Along with all of the other goodies we’ve been talking about endlessly for the last two years, the health care law is giving us another reason to celebrate: cold hard cash.

That’s right, cash money. Or more like a check. Let me explain.

The health care law signed by President Obama in 2010 to overhaul our health care system included a provision to require insurance companies to spend more of our premiums on our care, not on administrative costs or profits. It is called the Medical Loss Ratio (MLR) and it is a federal requirement that insurance companies must spend 80-85% of premiums on health care. When I talk about this with women across the country, one of the first things they say is something along the lines of, “It’s about time!” (That that seems a pretty normal requirement and one that should have been in place a long time ago.) Before the health care law, many insurance companies spent excessive amounts of our premium dollars on administrative costs and profits, including executive salaries, overhead, and marketing—and not on our health care. Read more »