the Coverage Corner

Genetic testing has become a hot topic in recent weeks due to news that actress Angelina Jolie underwent a double mastectomy to reduce her risk of developing breast cancer. Jolie had the procedure done after learning she carried the BRCA1 gene, which increases the risk of a woman developing ovarian and breast cancer. Many are wondering if genetic testing and the steps Jolie took are something other women can copy and whether it will be covered under their health insurance.

Obamacare Expands Genetic Testing for Patients
Under the new rules of the Affordable Care Act, new health policies are required to cover genetic counseling for women at high risk of having the BCRA gene. Often women that are deemed high risk are those with family members who have developed ovarian or breast cancer. Along with covering genetic testing, the ACA requires new health coverage to offer women over the age of 40 mammography screenings every 1 to 2 years without making them pay a copay or coinsurance.

Although the Affordable Care Act covers genetic testing, it does not require insurers to cover double mastectomy procedures. However, the law does help patients with appealing an insurer’s decision to not pay for procedures.

What Genetic Testing Normally Costs
If you chose not to buy insurance and be subject to the ACA tax mandate, preventive genetic testing can cost a hefty amount. Depending on the facility and the genetic test performed the price can range from anywhere between $300 and $3000. This cost can often deter women at high risk from getting the test performed, which is why insurance is now required to step in.

The price for double mastectomy procedures can vary. The price for Jolie’s procedure was estimated to be around $20,000 but it can often be much more.

In honor of Mother’s Day and all the special women in our lives, we’re celebrating National Women’s Health Week. This year’s 14^th annual National Women’s Health Week will be observed from May 12 – 18, 2013 and provides an opportunity for women of all ages to take time out to ensure they are doing everything possible to lead a healthy lifestyle.

Throughout the week, women are encouraged to take action by scheduling checkups and preventive screenings; also to evaluate their healthy eating, activity levels and mental health.

The Women’s Health Movement

Recognizing that advances in women’s health and well-being in the past have been far and few between, President Obama has committed to helping girls and women get the health care they need through the Affordable Care Act. The new health law has brought a new era of equality and given women control over their health.

Starting in 2014, women will no longer face higher insurance premiums due to their gender or be denied coverage due to pre-existing conditions such as pregnancy or cancer. 47 million women have already gained access to preventive services at no out-of-pocket cost, including domestic violence screenings, counseling, contraceptive care and more.

Regular health screenings and checkups should be a priority and are essential to leading a long and healthy life. Early detection can increase survival chances and save lives. Thanks to the Affordable Care Act, women can receive these preventive screenings without out-of-pocket costs like copays.

Resources for Women

As we focus helping women achieve longer, healthier lives, there are several great resources available to those interested in learning and participating in wellness-focused behaviors. Schedule a conversation with your doctor or take advantage of the Department of Health and Human Services professional women’s health resources. You can find specific ways to improve your health, learn about women’s health campaigns and programs and view statistics, health guidelines and more.

Help us kick off National Women’s Health Week by ‘liking’ our Facebook page! All week, GoHealth will donate to the Healthy Women organization for every 50 new ‘likes’ to our Facebook Page.

This week it’s all about the ladies. Women’s Health Week officially kicks off on May 12, and for one week the focus will be directed towards the health and wellness of women. With a whole week dedicated to the health of women everywhere, we’ve assembled some important information on what the Affordable Care Act (ACA) means to women.

1. Women can no longer be charged more for health insurance. Before the ACA became law, simply being a woman meant that you could be charged higher insurance rates. No longer will insurers be allowed to charge women higher premiums and rates than they charge men.

2. All plans must provide maternity coverage. Coverage for ‘essential health benefits,’ must be included in all health insurance plans, including maternity coverage and other basic health care services including newborn care, prescription drugs, pediatric services and more.

3. Preventive care will be provided at no cost-sharing. New laws require health plans to cover preventive services such as health screenings, vaccinations and more without charging a co pay. This law, estimated to grant 47 million women access to guaranteed preventive women’s health services, applies to new health plans created after March 23, 2010.

4. No longer turned down for coverage due to pre-existing conditions. Previously, individuals with pre-existing conditions could be turned down by insurance companies. The new health law ensures that women will not be denied coverage based on previous or current medical conditions.

5. Single women will now be eligible for Medicaid. Medicaid expansion is a crucial part of the health care law and an important source of health care for low-income single women. In 2014, individuals with incomes up to 133 percent of the federal poverty line will be eligible for coverage. This expansion will help an estimated 7 million women become newly eligible for Medicaid.

6. Women will also be eligible for subsidies to help buy health insurance. Starting in 2014, the ACA provides tax credits to those who cannot afford quality health insurance. Women purchasing insurance starting January 1, 2014 through a marketplace are eligible for subsidies or cost-sharing if their income is less than 400 percent of the federal poverty level.

In 2014 the individual mandate, a major provision of the Affordable Care Act (ACA) kicks in, which requires U.S. citizens and legal immigrants to have health coverage. Those who fail to get health insurance will face a tax penalty. You may be asking yourself whether it’s more advantageous to buy health insurance now or wait until 2014. Here are some considerations to help make that decision.
If you buy now:

• You will likely pay lower premiums. The new provisions that will be enforced under the ACA in 2014 (essential health benefits, modified community rating, and guaranteed issue) are estimated to cause a jump in individual health insurance premiums.
• More personalized coverage. By shopping for an insurance plan now, you may find a less robust plan that only includes the benefits you need, helping cut unnecessary costs. For those that are young and healthy, chances are an insurance plan will cost less.
• Changes in age-rating may increase or decrease premiums. If a young adult purchases coverage now, they are not subject to changes in age-rating created by reform. For example in 2014, an older adult cannot be charged more than 3 times a young adult. This will increase individual premiums for young adults but in 2014, this will decrease premiums for older adults.

If you wait until 2014:

• More reliable options. You’ll know you’re getting a Qualified Health Plan at an affordable price by purchasing insurance directly from state’s health insurance marketplace. Shoppers will be able to compare plans that meet certain benefit requirements.
• Essential health benefits. All plans are required to cover “essential health benefits,” which include coverage for prescription medication, maternity care, hospitalization, ambulatory care and more.
• Guaranteed issue. Effective in 2014, individuals cannot be refused coverage from an insurance company because of a pre-existing condition, nor can they be charged higher rates due to gender or health status.
• Tax Subsidies. You could be eligible for tax credits if your household income falls between 100 to 400 percent of the poverty line.
• Annual Dollar Limits. In 2014, the use of annual dollar limits on essential benefits like hospital stays will be banned for new plans in the individual market and all group plans.

Health insurance exchanges are set to open a mere five months from now, and it’s important to know where you stand. Listen in as  health care experts including Michael Mahoney, Vice President of GoHealthInsurance discuss the Affordable Care Act, how Illinois is preparing for the health exchanges and what you as a consumer need to know come fall — whether you’re insured or not.

 

A brand new type of open enrollment is on the way under the Affordable Care Act (ACA)! A first of-it’s-kind — an individual health insurance open enrollment period will start this October 1, 2013 and end March, 31, 2014.

This infographic provides the necessary details to get you started this open enrollment period.