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
Insurance companies sometimes try to cut costs by substituting less expensive drugs for a specific drug prescription. That's raising problems in many cases, and actually causing harm. share
Health reform proposals like Medicare-for-all or Single Payer would shift around the health care system and could produce cost savings, but those savings would in part come from the elimination of jobs for insurance brokers, hospital staff, and others. share
Congressional Budget Office experts outlined the complexities of implementing an overhaul of America’s health insurance system. share
Most Americans say the government should take action to prevent surprise medical bills. Here is what Congress is doing to fight them. share
African-American women aging with HIV often have histories of abuse and trauma, in addition to other medical conditions. A few share their stories. share
Experienced health care journalists discuss Medicare for all (also known as Single Payer) and why enthusiasm may be decreasing; proposals to increase the age to purchase tobacco; and surprise medical bills. share
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
Women who are subject to violence – often from intimate partners – are more likely to turn to opioids or other substances leading to further health and life problems, including increased risk for HIV infection. share
Treatment of Opioid Use Disorder in California with Medication Assisted Treatment (MAT) has increased through greater use of Buprenorphine – one of two major medicines used to treat OUD. share
Limiting surprise medical bills – when someone gets a bill for health care that is much larger than they had expected is an area of bipartisan agreement in Congress. 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