Affordable Care Act and women and families
The Affordable Care Act (also called the ACA or Obamacare) gives Americans new choices in health insurance (also called health coverage or health plan). Health insurance helps you pay for medical care.
The law makes new rules for the kinds of health care services that a health plan offers and what you have to pay for these services. Certain services may be important to you if you’re pregnant, thinking about getting pregnant or already have children. Learning what different plans cover and how much they cost can help you choose a plan that’s right for you and your family.
If you’re a woman of childbearing age (18 to 44 years), how does the ACA affect your health care?
The ACA says that all insurance plans have to fully cover preventive care services for women with no co-pay. These are services, like vaccinations and screening tests, that can help prevent certain health conditions or find them early so you can get started on treatment. For example, you can get services like a well-woman checkup, breast cancer screening or birth control without having a co-pay. A co-pay is money you pay for each health care service you get, like a visit to a health care provider.
To see a list of covered preventive health services for women, go to: www.healthcare.gov/what-are-my-preventive-care-benefits#part=2
The ACA also makes sure you can see a provider for women’s health services without a referral from your primary care provider. Women’s health services include things like birth control, breast cancer screening and prenatal care. So you don’t have to go to your primary care provider (someone who gives you basic health care) first to get an OK to see a women’s health provider, like an obstetrician/gynecologist (also called OB/GYN), nurse-midwife or nurse practitioner.
If you’re pregnant or thinking about getting pregnant, how does the ACA affect your health care?
It’s a great idea to find out about and get treated for health conditions before you get pregnant. Some health conditions, like high blood pressure and diabetes, can cause problems during pregnancy. So it’s important to make the most of preventive health services for women covered by the ACA, especially if you’re starting a family.
The ACA says that health plans have to cover many services for pregnant women, including:
- All prenatal care visits with no co-pay. Prenatal care is medical care a woman gets during pregnancy. No co-pay means you don’t have to pay your provider each time you go for a checkup.
- Labor and delivery services
- Breastfeeding help with no co-pay. This includes visits with a lactation consultant, breastfeeding equipment and breast pumps. A lactation consultant is someone with special training in helping women breastfeed.
When you’re choosing your health plan, look at the plan summary. Each plan has a summary that includes the expected costs of pregnancy under that plan. Every summary uses the same form, so it’s easy to compare costs and services. Plan summaries are available in the Health Insurance Marketplace. This is an online resource that helps you find and compare health plans in your state. Find your state’s Marketplace at: www.healthcare.gov/what-is-the-marketplace-in-my-state
Some pregnant women need help paying for health insurance. In most states, pregnant women can get Medicaid coverage even if they earn more than other low-income adults. Medicaid is a government program that provides free or low-cost health insurance to people with low income. In some states, pregnant women who earn too much for Medicaid can get coverage through the Child Health Insurance Program (also called CHIP). CHIP is a government program that provides health insurance to children in certain families with low income. If you’re looking for insurance in the online Marketplace and you say you’re pregnant on the Marketplace application, you get specific information about these and other health plans for pregnant women.
For more about insurance and planning pregnancy, go to: http://www.marchofdimes.com/pregnancy/are-you-ready-financially.aspx
If you’re a parent, how does the ACA affect health care for your children?
The ACA says that insurance plans have to cover certain health services for children, including:
- Well-child checkups with no co-pay. These are checkups your child gets when he’s not sick. No co-pay means you don’t have to pay your child’s provider each time you take him for a check-up.
- Vaccinations with no co-pay. These are shots your child gets that help protect him against certain diseases.
- Visits to a health care provider when your child is sick.
To see a full list of health care services for your child that don’t have a co-pay, go to: www.healthcare.gov/what-are-my-preventive-care-benefits#part=3
Your child can stay on your health plan until age 26, even if he doesn’t live with you or is married. If this child isn’t covered by your insurance now, you may be able to add him to your plan. But you may have to add him in a certain amount of time. Check with your insurance plan about adding older children to your coverage.
If you get insurance through your employer, you most likely can get family coverage. This is a plan that takes care of you, your partner and your children. But getting help to pay for insurance for your children can be confusing. Sometimes children can get coverage that their parents can’t. Some states have health plans that only cover children (called a child-only plan). Sometimes children in the same family get different kinds of coverage depending on how old they are.
For more information on health insurance and children, go to: www.healthcare.gov/law/information-for-you/families.html
If your child has special medical needs, how does the ACA affect her health care?
The ACA can help make sure that children with special medical needs have the health insurance they need to pay for services and treatment throughout their lives. For example:
- Insurance plans can’t deny coverage or charge you more money for a child with a pre-existing condition. This is a health condition that your child has before you sign up for health insurance.
- Insurance plans can’t set a lifetime limit on health insurance. This means that a health plan can’t say it only pays for services up to a certain amount of money. The plan has to cover a child’s medical treatment for as long as the child is covered by the plan.
- Insurance plans have to set a cap (limit) on annual out-of-pocket expenses. Out-of pocket means the amount of money you have to pay for health care services. Health plans have to set an annual limit on the amount of you spend out-of-pocket for your care each year. Once you reach this limit, your health plan fully pays for health care services.
- Medicaid may help some children with wrap-around services. In some states, children with special health care needs covered by private plans may be able to get coverage from Medicaid. This coverage is called a wrap-around service. In these cases, Medicaid may cover services not covered by a private plan. Or it may pay for more provider visits than a private plan allows. To learn more about Medicaid wrap-around services, visit: www.healthcare.gov/do-i-qualify-for-medicaid/
Your child’s health can affect which insurance plan you choose. If your child has a medical condition, you may want to choose a plan that covers your child’s health care provider or prescription medicine. And if your child has a condition that requires special vision or dental care, you may want to choose a plan that covers those services. Some plans pay for vision and dental services for children, while others have limited coverage. Check the plan’s summary for a list of costs and coverage for children’s eye exams, glasses and dental checkups.
Most common questions
What is happening with health care reform?
While some provisions take effect this September (see our In-depth article), the new law will not fully go into effect until 2014. In the interim, the March of Dimes is reviewing and commenting on the rules for implementation that are being issued by the Administration.
The March of Dimes will update this site on items that directly affect women of childbearing age, infants and children, but to get even more information about all of the advances, visit http://www.healthcare.gov/.
Where can I find out about getting insurance coverage for my child?
The first place to inquire is with your state insurance commissioner's office. The U.S. Department of Health and Human Services also has a Web site to help parents determine if their children are eligible for free or low-cost health coverage under the reauthorized Children's Health Insurance Program. Visit http://www.insurekidsnow.gov/ for more information.
Why did the March of Dimes support health care reform?
Since our founding, the March of Dimes has worked to shape public policy that affects maternal and child health. Health reform offered an unparalleled opportunity to improve the health of and address the needs of women, infants and children. Specifically:
- Expanding and improving coverage for maternity and pediatric care
- Strengthening Medicaid (which covers more than 40% of all births)
- Increasing the number of currently uninsured women of childbearing age and children who will be covered in 2014
By law and longstanding tradition, the March of Dimes is strictly nonpartisan and remained nonpartisan throughout the debate. Initially, we worked with members with many different views and party affiliations, but as the debate went on, we focused our energies on ensuring that legislation likely to be approved contained the strongest provisions possible to address the unique health needs of children and pregnant women.