I recall pregnancy/maternity services were covered, but not pediatric anything Didn't you have family coverage??? I imagine I could have eliminated it from my plan but that would not have been prudent and saved peanuts......
Why does everyone have to be covered for maternity care? The Affordable Care Act requires insurers to cover 10 essential benefits with no lifetime or annual limits:
1) Outpatient care
2) Emergency care
3) Hospital stays
4) Mental health services
5) Prescription drugs
6) Rehab services
7) Lab services
8) Free preventive care
9) Maternity and newborn care
10) Pediatric care (including vision and dental services)
Not all of us will use all of these services: You may never need therapy, for example, or never have an accident worthy of the E.R. (It’s nice to know you could afford them if you needed them, though—right?) But under the Affordable Care Act, insurers can no longer discriminate by gender (women have historically paid more than men, even without maternity coverage) or preexisting conditions—only by age or smoking status. That means all plans have to essentially look the same.
“If it were personalized, [insurers] would be looking at you, saying, ‘You’re a certain age, you have a family history of heart disease and cancer, you had high blood pressure five years ago. So we should charge you more,’” says Wood. “But that’s not how we’re doing it. Everyone is in, everyone pays a fair rate, and we have enough money in the system to take care of people when they need it.”
So why is everyone obsessing over maternity care? Because it’s gender-specific—but there’s a good reason to include it. “Maternity care has been a huge gap for women in the individual insurance market,” says Salganicoff. “It was considered a pre-existing condition.” That means women facing unexpected pregnancies would often find themselves uninsured—which is why Medicaid was paying for half of all deliveries, says Wood.
Even though this differs from the traditional structure of individual plans—which are essentially à la carte policies—this “new” comprehensive model is actually quite similar to the existing employer-based approach. Says Wood: “Employer-based plans all cover maternity care, even for men, because they’re providing all medically necessary services.” (Salganicoff adds that the Pregnancy Discrimination Act of 1964 made it illegal for employers to not cover maternity care).
Read: Men with workplace plans are already paying for the pregnancies they’ll never have.
“This is the model of health insurance—that you need to have a pool of individuals, a collective risk,” says Salgnicoff.
Again, that means not every person benefits from every benefit. And although the list specifically mentions maternity care, there are male-specific services covered, too, like care for prostate or testicular troubles and an abdominal aortic aneurysm screening for men who’ve never smoked. “Men and women are biologically different,” says Salganicoff. “Covering one service for women doesn’t mean you are discriminating against men.”
womenshealthmag.com |
