Ladies, it’s a fact that our health needs are different than those of men.  Due to our genetic make-up, there are many other health concerns that we must consider when choosing our health insurance plan.  The future is unpredictable, so it is important that we get coverage for all our current and potential future conditions.

Questions all women should ask about their health insurance coverage

1. Does my health insurance plan cover health screenings recommended annually for women?

It is recommended that women have annual mammograms, cervical cancer screenings, and osteoporosis screenings beginning at a certain age.  There are others important annual tests, but these tests are specific to women. The law requires that health insurance companies offer coverage for one annual mammogram for women 40 and older to prevent breast cancer.  Most states mandate that insurance companies cover an annual cervical cancer screening, such as pap smears.  Also, health insurance companies are required to offer coverage for annual osteoporosis screenings since they are necessary for health maintenance.  Osteoporosis tests begin around age 60.

2. Does my health insurance company cover specialty doctor visits?

Most health insurance companies cover for your OB/GYN services.  But it is important to check your health insurance plan to see what costs and treatments are covered because some are excluded from insurance.  For example, sterilization is rarely covered by health insurance companies.

3. Will my pregnancy be covered by health insurance?

Today, the average cost of having a baby is over $6000. Health insurance companies will most often cover doctors office and hospital visit expenses (with a small co-payment).  But there’s a catch: you must have health insurance before you get pregnant! Women who are already pregnant are considered “high-risk” candidates and it will be much more difficult to get coverage.  Other things you may want to check with the insurance company is if they offer coverage for services during your pregnancy (associated with the pregnancy but not the typical office visits) and prescriptions for possible depression. Even if you don’t needs these, better safe than sorry!

4. What if I need infertility treatments? Is that covered?

Infertility insurance is limited, but you’re not out of luck.  There are 14 states with mandates for health insurance coverage of infertility treatments.  If infertility treatments are not specifically excluded form your insurance plan, you can get coverage.  If needed, get a copy of your plan from your health insurance provider.  Otherwise, infertility treatment coverage is also offered by private insurance companies.

5.  Does my health insurance cover all of my prescription drugs?

There are many prescription pills specifically for women, such as contraceptive pills.  Generally, contraceptives have not been covered by health insurance companies in their plan. But, each insurer is different.  It is important to ask your provider because they may offer contraceptive coverage.

6. Is there coverage for treatment against diseases common to women?

Women are at a higher risk for osteoporosis, breast cancer, cervical cancer, and many others.  It is important for women to take preventative measures in their healthcare as well as have insurance for their expenses.  Vaccines are common preventative measures, such as Gardasil, a vaccine to prevent HPV and cervical cancer.  Many insurance companies cover this preventative vaccine because it reduces the chance of future medical conditions. However, check with the health insurance provider you are considering before making the final decision.

It is important to get coverage before you become ill.  Difficulty arises with health insurance coverage if you are already ill because the insurers many consider it a pre-existing condition.  Or some companies may offer coverage for office visits and pharmacy charges, but have you on a waiting list for any other treatment coverage you may need.

Today is the deadline for states to submit details to the Department of Health and Human Services on how they intend to operate the high-risk health insurance pools mandated by healthcare reform. The high-risk pool program is intended to provide coverage to those who have been denied health insurance because of a pre-existing condition and who have been without coverage for more than six months. These pools are meant to bridge the gap for such individuals until subsidies and new health insurance exchanges are instituted in 2014. Other crucial reforms included in the package which brought on these pools are provisions that allow individuals to stay on their families’ insurance plans up to age twenty-six, prevent insurers from excluding children because of preexisting conditions, and eliminate lifetime limits on health costs imposed on policyholders. Twenty-nine state and the District of Columbia have elected to run their own pools and will be entitled to a portion of the $5 billion allocated by the federal government to fund them. Nineteen states said they would leave operation of pools in their states to the federal government. Some think tank analysts and state officials worry that federal funding may run out, leaving states liable to cover these high-risk patients out of their own budgets. Federal officials at the Department of Health and Human Services have assured these doubters that the funds will last for until 2014 in states where it will administer the pools. They further say the federal government will cover the costs of developing or modifying accounting or enrollment systems and any other start-up costs states may incur. The contracts due to Health and Human Services today must include strategies for operation of the pools, estimations of total cost, and other provisions. Enrollment in the pools begins July 1 and coverage for policyholders will begin August 1. For more information on the high-risk pools in your state, contact your state’s Department of Insurance.

Obama administration officials and some Senate Democrats are optimistic that the federal subsidy of COBRA benefits passed by the economic stimulus bill will be extended by inserting  a provision to this effect into the “extenders” package of jobless benefits working its way through the Senate this week. This bill is co-sponsored by Senators Bob Casey Jr. (D-PA) and Sherrod Brown (D-OH). As discussed in my last post here, it is estimated that over 2 million families who would have lost their employer-sponsored health insurance as the result of a lay-off took advantage of the COBRA subsidy. Instead of losing their coverage, COBRA has allowed them to keep their previous employer’s health insurance and the federal government’s subsidy has paid for 65% of the total cost of maintaining that coverage. This subsidy was a huge help for families who otherwise would have had to assume 100% of the total cost of premiums (including the portion their employer used to pay) to maintain their coverage under COBRA.

COBRA Subsidy Running Out for the Unemployed

As of June 1, 2010, the 15-month COBRA subsidy has expired for those who took advantage of it when it first became available in February 2009. The National Employment Law Project estimates that more than 144,000 households each month will be dropped from the subsidy as these families hit their 15-month mark. Many families whose COBRA subsidy has not yet expired hope the Senate will pass this extension of the COBRA subsidy beyond the 15 month mark so that they can continue paying just 35% of the total cost of their previous employer’s insurance premiums and keep their old coverage. Here are five reasons why I don’t think an extension of this subsidy will make it into the final jobless benefits package which should come to a vote this week:

1)      Centrist House Democrats rejected a similar proposal to extend COBRA subsidies in May 2010 because of concerns about continuing to run-up the national deficit.

2)      Last week, the non-partisan Congressional Budget Office evaluated the Senate’s trimmed down version of the proposal which is in currently in the works. Extending the COBRA subsidy again is estimated at $4.1 billion, which is much higher than supporters had anticipated.

3)      Congress already extended the subsidy once in November 2009, allowing COBRA beneficiaries to continue receiving the 65% subsidy of their total premium cost for a maximum of 15 months. The original subsidy as passed in the American Recovery and Reinvestment Act of 2009 was set to expire after 9 months.

4)      There are few other areas of the bill from which co-sponsors Sens. Bob Casey Jr. (D-PA) and Sherrod Brown (D-OH) can pull funds for the subsidy. The subsidy extension is only part of a package of provisions the Senators are trying to attach to the must-pass legislation. Their whole package has a total cost estimated at nearly $7 billion. Other parts of their provisions would extend unemployment benefits and make changes in dozens of federal programs, and these are not areas from which the senators could easily justify cutting funding in order to make room for another COBRA subsidy extension.

5)      A similar proposal to extend the COBRA subsidy was dropped from the House-passed bill. Additionally, Senate Democratic leaders omitted it from their version when the bill was originally drawn up.

Unfortunately, it seems that given the strained economy and need for budget-consciousness in Washington families who have relied on the federal subsidy to keep their coverage under COBRA will have to reevaluate their options.

According to Hartford Business online, the Connecticut State Government is debating on passing a bill which will mandate expanded coverage for more than six medical conditions. Such mandates would add approximately 3% to total premiums, according to insurance experts.

The six medical condition mandates for the new proposal include: ostomy-related supplies, prosthetic devices, hearing aids for children and wigs for patients who experience hair loss due to medical conditions. These mandates would cover what is typically paid for out of pocket, therefore increasing premium costs.

Thousands of families who took advantage of the federal government subsidy for extending their former employer’s health insurance coverage through COBRA have had to rethink their options in the past few weeks. On June 1, 2010 the federal government’s subsidy of COBRA health plan extensions expired. COBRA is a federal program which allows workers who have been laid off to continue the health insurance benefits their families received through their job after their employment has been terminated. With employer-sponsored coverage, companies contribute a given portion of the cost of their workers’ health insurance premiums and workers pay the rest. When a worker is laid off, COBRA gives that individual the option to remain on the same insurance plan as long as they agree to pay the total cost of monthly premiums themselves. Unfortunately, the full burden of such premiums is often too onerous for unemployed individuals to bear, especially in economic times such as these. That’s why as part of last year’s economic stimulus package, the federal government offered to subsidize the cost of extending one’s old coverage through COBRA at 65%. This subsidy was available beginning March 1, 2009 and offered 15 months of subsidized coverage to those who took advantage of the extension.

According to a study by the Treasury Department up to 1/3 of eligible unemployed workers signed up for the program. Last Tuesday, this benefit expired leaving thousands of families who took advantage of the opportunity to extend their health plan feeling they can no longer afford to continue this coverage without the help of the subsidy.  One exception to the June 1, 2010 expiration date remains for those who did not become unemployed until more recently. Those families who accepted the COBRA subsidized extension after March 1, 2009 but before December 31, 2009 are able to continue COBRA until September 30, 2010 when the subsidy expires completely. These families will be dropped off COBRA on a rolling basis based on when they signed up.

Though Congress has extended the COBRA subsidies four times since February 2009, the most recent proposed subsidy extension failed due to worries on the part of legislators about the federal budget deficit. Some states are offering additional COBRA extensions (called “mini-COBRA” laws) to supplement federal COBRA to extend benefits up to 36 months but again, the cost of these premiums tend to be much higher than those for plans available on the individual market.

Recently we have had many families losing their COBRA coverage visit our website to look into other, less expensive health insurance options offered on the individual and family health insurance market through us at Health Plan One. With individual and family plans, consumers are able to tailor their coverage so they only pay for the benefits which meet their specific needs. If you’re interested in doing your homework on the individual and family plans available to you, call one of our licensed agents at (877) 567-5267 for an expert, personalized consultation. Other public options for individuals with major preexisting conditions dropping their COBRA exist in most states, as do so-called “HIPAA-eligible” plans. Visit your state’s informational page at healthplanone.com to learn more about the publicly funded programs available in your area which benefit groups like pregnant women, children, and low-income families.