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
Rebates paid from pharmaceutical companies to pharmaceutical benefit managers are increasing, driving up costs for patients, and possibly increasing overall drug spending and prices. share
Medical marijuana is generating greater attention as more states legalize its use. However, there are many different active chemical compounds in the different strains of the cannabis plant. share
States are looking at laws to prevent patients from receiving very costly surprise medical bills from out-of-network providers sending patient bills under a practice called balance-billing. share
Congress’s must fix the impending "out-of-pocket cliff" for the Medicare Part D prescription drug program that could severely harm 44 million Americans. share
Prescription drug plans for Medicare that provide rebates back to patients rather that prescription benefits managers or payers have been offered, but not many people bought them. share
Websites for people looking for health insurance may lead them to brokers that offer plans that don’t meet ACA requirements, provide less information about the costs and coverage of those non-ACA plans, and which earn insurance brokers more money. share
A federal district court ruled that the ACA is unconstitutional raises doubts (again) about the law, even as more people benefit and premiums for ACA plans have stabilized. Listen to the podcast. share
Short-term health insurance plans may offer people lower monthly premiums, but do not cover as many benefits, and can exclude pre-existing conditions, as well as limit the amount of coverage or not have a cap on the annual amount the person has to pay. share
HealthyWomen Opposes Proposed Changes to Title IX’s Rules for Sexual Harassment and Assaults Involving Students
HealthyWomen opposes the proposed changes to Title IX because sexual harassment and sexual assaults have long-lasting consequences for women's physical and mental health. share
A federal district court ruled that the ACA is unconstitutional raises doubts (again) about the law, even as more people benefit and premiums for ACA plans have stabilized. share
In searching to save money on monthly insurance premiums, people may unwittingly sign up for plans that limit choice of hospitals, doctors and other sources for health care. share