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Understanding Women’s Health Insurance Coverage

PINK Breast Center

Health insurance coverage is a critical factor in making health care affordable and accessible for women. Although a majority of women residing in the U.S. have some form of coverage, gaps in the private sector and publicly funded programs have left over one in six women uninsured. Because women are more likely to be covered as dependents, a woman is at greater risk of losing her insurance if she becomes widowed or divorced, or her spouse loses a job.

More than half of women ages 19-64 received their health coverage through employer-sponsored plans while only about 5% of women purchased insurance on their own. For those who are uninsured, they often have inadequate access to care and have a lower standard of care resulting in poorer outcomes. Uninsured women do not have access to important preventative services such as mammograms and pap tests and are far more likely to forgo medical services due to do cost.

Affordability is clearly a concern for many women, not just those who are uninsured. Even those with private insurance have said they either delayed or went without needed healthcare due to cost. In 2014, the Affordable Care Act made significant changes through a number of insurance reforms and by expanding access to coverage through the health insurance exchanges known as Marketplaces.

One of the ACA’s primary goals was to reduce the number of uninsured through expanding access to care. Individuals with very low incomes can now qualify for Medicaid and individuals with certain income levels are able to receive subsidies in the form of tax credits if they purchase a plan through the Marketplace. You may also qualify for savings on out-of-pocket costs, known as cost-sharing reductions, allowing you to pay lower deductibles, coinsurance and copayments.

Additionally, coverage is available without any limits on pre-existing conditions and premiums cannot be based on gender or one’s health status. The ACA also requires health plans offered in the individual and small group markets cover certain “essential health benefits” (EHBs) that fall under 10 different categories – ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventative and wellness services and chronic disease management; and pediatric services, including oral and vision care.

It’s important to note that preventative services are offered at no cost which means you do not have to satisfy a deductible and can’t be charged a copayment. Some of the preventative services covered include vaccines and immunizations, blood pressure and cholesterol screenings, colorectal cancer screening, mammograms, well-women care including pap tests, contraception, and screenings for children including vision and hearing.

Women tradionally have been the primary caregivers for their family’s health needs, whether it’s for their children, family members, or parents. As caregivers, it’s important for us to take care of our own health and make sure we fully understand the options available and best suited for our needs and those of our family.

For more information about health insurance coverage or whether you may qualify for a tax credit, go to Knowing that your mammogram is a covered screening exam, take the time and schedule your exam at PINK Breast Center today. We have 2 NJ Diagnostic Center’s at your convenience: Paterson at (973) 977-6662 or in Flemington at (908)-284-2300.


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