Health Care » Choice of Plans

While many insurers claim women’s additional reproductive health costs justify their gender-rating, few actually provide maternity coverage.

Many women are severely limited in their choice of insurance coverage. Women are more likely to own or work for the smallest businesses, which struggle to provide health insurance coverage to employees.

Women also are more likely to work for firms that pay low wages, about three-quarters of which are smaller firms which often deny employees a choice in insurance plans, if they offer coverage at all. This situation is made worse by the fact that insurance markets across the country have consolidated to a dangerous level, especially in rural and low-population states.

A recent report by Health Care for America Now showed more than 400 corporate mergers involving health insurers in the past 13 years, leaving one or two large insurers dominating many statewide markets. In Alabama for example, one insurer controls 89 percent of the market. Such monopoly power allows insurers to increase premiums to outrageous levels, forcing people to choose between unaffordable premiums and going without insurance. This puts them at risk for poorer health outcomes.

And while it is important to have an opportunity to choose a plan, too many choices can be overwhelming and can actually have negative consequences, especially if there is a lack of clear information on how to compare plans.

For millions of American families, women will be gathering the information, comparing plans, and making the decision about which plan is best. Yet many women still do not have easy access to a computer with an internet connection. These women need a trusted independent resource where they can get unbiased information about plan choices so they can assess plans based on cost, quality, provider network, and comprehensiveness of benefits. It also is essential that women are informed about what their family’s likely financial exposure will be with any given plan.

Our Recommendations

A health insurance exchange can help consumers make informed choices by fostering a transparent marketplace where insurers compete for enrollees based on the cost and quality of their benefit packages. Any insurer participating in the exchange should be required to offer a minimum benefit package that covers a basic, comprehensive set of services with limits on out-of-pocket costs. Beyond this basic package, the exchange should establish tiers of plans with restrictions on benefit design to maximize choice while ensuring that insurers cannot target their benefits packages to healthy, less costly consumers by offering discounts on gym memberships but not covering certain chemotherapy drugs, for example.

To ensure that consumers are not overwhelmed, the exchange should limit the number of plan options. Each tier of coverage in the exchange also needs a clearly-defined benchmark. While there has to be some flexibility in plan design to encourage innovation and give people choices that meet their needs, there must be standards that make it easy for consumers to compare plan benefits both within and across tiers. States can help provide consumers by providing information and trouble-shooting services so they can make the best decisions for themselves and their families. The exchange should have up to a one-year enrollment period in order to give women and families sufficient time to understand their options and make informed choices.

Trusted nonprofit consumer organizations can educate and advocate for individuals and communities with help-lines and walk-in aid centers.

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(This information and more is included in our detailed report, Health Care Reform: What Women Need.)