By Dr. Huy Nguyen

Fewer Co-pays Mean Improved Access to Quality Comprehensive Care for Women

August 1 marked a new milestone under the Affordable Care Act, as co-pays have been eliminated for several preventative services for women. The removal of cost-sharing requirements makes way for improved access to comprehensive quality health care for all women. The changes, which take effect on insurance policies renewing on or after August 1, come a year after the Office of Health and Human Services adopted historic new guidelines for women’s preventative services.

In total, women will now have access to eight new preventative services that require no co-pays. They range from contraceptive coverage to so-called annual “well-woman” visits. As part of the transition, recommended preventative services will also be free for individuals on Medicare.

Dr. Paula Johnson, Chief of Women’s Health at Brigham and Women’s Hospital and Chairperson of the Boston Public Health Commission’s Board of Health, lauded the changes, saying they “will enable women to get the essential preventive care we know is so important to their health, which has tremendous implications for women in Boston and across the country. They build on an already robust set of preventive services offered without co-pay by the Affordable Care Act.”

The eight new preventative services to be covered without cost-sharing requirements include:

  1. Well-woman visits: These annual preventive care visits allow adult women to obtain recommended preventive services and additional visits if a patient’s health care providers determine they are necessary.
  2. Gestational diabetes screening: This screening is for women 24 to 28 weeks pregnant and those at high risk of developing gestational diabetes. It will help improve the health of mothers and babies, as women who have gestational diabetes have an increased risk of developing type 2 diabetes in the future.
  3. HPV DNA testing: Women that are 30 and older will have access to high-risk human papillomavirus (HPV) DNA testing with their cervical cancer screening every three years, regardless of their Pap smear results. Early screening, detection, and treatment have been shown to help reduce the prevalence of cervical cancer.
  4. STI counseling: Sexually-active women will have access to annual counseling on sexually transmitted infections (STIs).  These sessions have been shown to reduce risky behavior in patients.
  5. HIV screening and counseling: Similar to the STI counseling, sexually-active women will have access to annual counseling on HIV.
  6. Contraception and contraceptive counseling: Women will have access to all FDA-approved contraceptive methods, sterilization procedures, and patient education and counseling. Contraception has additional health benefits like reduced risk of cancer and protection against osteoporosis.
  7. Breastfeeding support, supplies, and counseling: Pregnant and postpartum women will have access to comprehensive lactation support and counseling from trained providers, as well as breastfeeding equipment. Breastfeeding is one of the most effective preventive measures mothers can take to protect their health and that of their children.
  8. Interpersonal and domestic violence screening and counseling: Screening and counseling for interpersonal and domestic violence will be provided for all adolescent and adult women. An estimated 25% of women in the United States report being targets of relationship violence during their lifetimes, and screening has been shown to be important in the early detection and effectiveness of interventions to increase the safety of abused women.

The sweeping changes do come with some caveats. For one, the timing of a woman’s eligibility may vary by health plan, and for some patients may only be available upon plan renewal. There are also some exemptions for group plans and for religious organizations. Dr. Johnson suggests that women contact their health plan to find out what services are available to them and when the new benefits go into effect.

In addition, the rules governing coverage of preventive services, which allow plans to use reasonable medical management to help define the nature of the covered service, also apply to women’s preventive services. Health care plans will retain the flexibility to control costs and promote efficient delivery of care by, for example, continuing to charge cost sharing for branded drugs if a generic version is available and just as effective and safe.

Additional resources and information:

Full list of 22 covered preventive services for women

Final rules and regulations

Guidelines for Women’s Preventive Services

Fact sheet on Women’s Preventive Services and Religious Institutions

Dr. Paula Johnson’s WBUR CommonHealth article

Dr. Nguyen is the medical director at the Boston Public Health Commission and a pediatrician at the Dorchester House Multi-Service Center.

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