acaThe Affordable Care Act (“ObamaCare”) was signed into law to reform our healthcare system in 2010, upheld by the Supreme Court in 2012, and began its big rollout last year with the most significant aspects of the legislation in place by January 1, 2014. This controversial new law was made even more complex by the issues related to the launch of the Healthcare.gov website. Consequently, you may not be clear on all of The Affordable Care Act’s benefits. While we healthcare providers are also in a period of adjustment – which will continue to evolve as reforms continue to rollout, the initial changes have already made significant impacts.

The good news is that 47 million women now have access to preventative health services and the law also makes it illegal to charge women different rates from men.  (For more on benefits specifically geared toward women, click here.)

And from our standpoint as your OB/GYN provider, here are some key points about how The Affordable Care Act affects you:

1) It is a blessing to many women due to the fact that many preventative services are now guaranteed by the law. Annual well-woman exams (i.e. pap smear, pelvic exams, associated lab tests, and annual checkups with no additional issues) are now a covered benefit on all insurance plans. This means that you are entitled to visit the gynecologist once per year without a co-payment. Similarly, if you are over 40, recommended mammograms are now covered without a copay. After age 50, screening colonoscopies, which are recommended every five to ten years, will also be covered without a copay or deductible. Altogether, this coverage offers a significant savings to individuals and helps prevent women from opting out of preventive care due to cost.

2) Birth control is now required to be covered by insurance plans. My official response to this aspect of The Affordable Care Act is: HOORAY! Now birth control may be cheaper than Viagra for men, and that is a tremendous advance =) Please note that insurance companies are still allowed to require generics, so if you need a specific oral contraceptive that is not yet in generic form, insurance may not cover it or may require a higher copay. If possible, the doctor can request prior authorization from the insurance company for payment or coverage, but it is unclear how coverage decisions are actually made. Our office will do our best to help get you the contraceptive pills that work best for you.

Additionally, another excellent birth control option that’s now covered and one that I particularly recommend is the intrauterine device (IUD). Both the ParaGard (copper) and Mirena (progestrone) IUDs are fabulous, efficient methods of birth control – 99% effective, reversible, and very well tolerated – that in the past were often too expensive for young patients. Now that the IUD is covered, I hope more and more women choose this option.

3) “Ten Essential Benefits,” which are provided with no out-of-pocked limits to the amount of care you can receive, must now be included under all insurance plans in the Healthcare.gov Marketplace. The following will not have any lifetime or annual dollar limits:
• Maternity and newborn care
• Pediatric care, including vision and dental care.
• Preventive care, wellness services, and chronic disease treatment
• Prescription drugs
• Emergency services
• Hospitalizations
• Laboratory services
• Mental health and substance abuse treatment
• Outpatient, or ambulatory care
• Rehabilitative and rehabilitative (helping maintain daily functioning) services

4) The Affordable Care Act does not replace private insurance, Medicare, or Medicaid. It also doesn’t regulate your health care – it just regulates health insurance practices.

5) Young adults can now stay on their plan until age 26.

Like you, our office is also adjusting to the new healthcare provisions starting with the new healthcare exchanges and covered care of California. Connecting to routine insurance plans has always been a complex process for our office staff, and the new plans present new challenges. Change is difficult for everyone, and we promise to do our best to make the transition for you as smooth as possible as we continue to work to provide the highest level of gynecological and fertility care possible.

And speaking of providing the highest level of healthcare possible, we would appreciate your feedback about our office and also your current insurance coverage. Please take this survey, and thank you!

If you have questions about how The Affordable Care Act affects you, CONTACT US.