When it comes to policy issues, "access to care" focuses on women's access to health care services, products, and health insurance. This includes being able to find clinicians and care providers, including hospitals and pharmacies, that provide the care women need. Such care should be geographically accessible and covered by health insurance.
Access to insurance also involves being able to find coverage that meets a woman's needs and includes the doctors, other clinicians, and care providers that she and her family needs.
Affordability is a critical aspect of both types of access, which is why it is covered in its own section.
Access to doctors, clinicians and care providers can be limited by some health insurance plans' networks. For example, some insurance plans, such as health management organizations (HMOs), may not cover any care that patients receive from "out-of-network" providers or clinicians, while other types of health insurance may charge higher costs for patients who use out-of-network clinicians and providers.
For prescription medicines, most health plans have lists of medicines they will pay for, organized into different tiers or groups that each has its own cost for patients (say, $20 for a generic drug versus $40 for a preferred brand-name medicine, or 30% for "specialty" or expensive medicines). Some insurance plans also require separate deductibles for prescription medicines as well as preferred networks of pharmacies, either in-store or online.
In 2018, our nationwide WomenTalk® survey asked women to share their views on a range of health-related topics, including insurance barriers to quality care. Today these results are helping to inform our work, engage our partners, and importantly, keep you updated on health-policy issues that may affect your health, including Access to Care, Affordability, Preventive Care, Chronic Conditions & Policy, Opioid Use Disorder, Medication Safety, and Medical Research & Clinical Trials.
Understanding your insurance coverage
You should understand what your insurance plan covers (and what it does not) and what you are expected to pay, both in-network and out-of-network depending on your health care needs and the health care needs of your family. HealthyWomen believes insurance coverage should be understandable and transparent as possible so women and their families can make informed choices.
Navigating insurance networks for the information you need for decision-making isn't always easy. If you need an insurance plan to cover a particular physician or care provider, check directly with the physician's office or care provider. The information provided by the insurance company or health plan may not be accurate or updated regularly
Women buying health insurance for themselves and/or their families may have several options. While insurance available through the Affordable Care Act (ACA) marketplace exchanges (healthcare.gov), must meet all the requirements of the law, (including not charging people with pre-existing conditions higher premiums or denying them insurance, covering preventive services without cost, and covering maternity care and prescription drugs), other insurance options may be available with lower premiums. However, those lower-priced options may not meet the ACA's requirements and may not include coverage for certain services, such as maternity care and prescription medicines, which often were not included in many health plans sold prior to the ACA.
HealthyWomen opposed proposals to expand dramatically those types of health insurance plans, including Association Health Plans and Short-Term/Limited-Duration health plans because they will be able to discriminate against women based on their gender, age, or pre-existing conditions — and do not have to cover preventive services or maternity care.
If you are denied access to care, here are some actions you can take to challenge your insurer's decision.
In the news
We surveyed women with chronic conditions to find out about their ability to access necessary in-clinic treatment. share
People looking for lower cost health insurance may lead them to options that are scams not regulated by state insurance rules. These plans likely don’t meet ACA requirements and can leave people with very high health care the “insurance” won’t pay for, pa share
As a national movement for better access to menstrual products gains steam, “period equity” activists in Colorado are finding the path to change can be rocky. share
With Congress at a political impasse in finalizing a federal budget, a potential government shutdown means critical health programs are at risk. share
The excessive testing, Corl said, stemmed from a model of emergency care that forces doctors to practice "fast and loose medicine." share
You can make good decisions about health care insurance by being informed about the options that make the most sense for you and your family. share
The author of The Health Care Consumer’s Manifesto offers advice on how to advocate for yourself as you would for your loved ones. share
If the goal is expanding access and improving affordability, then building on the ACA is a better strategy. share
Individuals and families can shop for a new Obamacare health insurance plan during the 2020 open enrollment period under the Affordable Care Act. share