Some Plans Deny Pregnancy Coverage For Dependent Children (one est 70%)

[dkf]

The health care overhaul provides a safety net for young adult children, who can now stay on their parents' health plans until they reach age 26. But it doesn't guarantee that their parents' plan will cover a common medical condition that many young women face: pregnancy.

Group health plans with 15 or more workers are required to provide maternity benefits for employees and their spouses under the Pregnancy Discrimination Act of 1978. But other dependents of employees aren't covered by the law, so companies don't have to provide maternity coverage for them.

Although hard numbers aren't available on how many companies don't provide dependent maternity benefits, "I would say it's common," says Dania Palanker, a senior health policy adviser at the National Women's Law Center. And the number could grow with the recent expansion of coverage to children under age 26, she says.

Dan Priga, who heads the performance audit group for Mercer, a human resources consulting company, estimates that roughly 70 percent of companies that pay their employees' health-care claims directly choose not to provide dependent maternity benefits.
...
According to the March of Dimes, the average cost for uncomplicated maternity care was $10,652 in 2007. That includes prenatal care, a routine delivery and three months postpartum care.

http://www.kaiserhealthnews.org/features/insuring-your-health/2012/under-26-pregnancy-coverage-michelle-andrews-080712.aspx

Still On Your Parents' Insurance? Great! Just Don't Get Pregnant

Under the Affordable Care Act, people up to age 26 are eligible to qualify as dependents on their parents' insurance policies. This is great news if you're one of the thousands of newly minted graduates wallowing in un- or underemployed post collegiate hell, but it's less awesome news for women who, in their prime reproductive years, might find themselves SOL if they get pregnant — parental insurance plans, as a general rule, do not cover abortion or maternity costs. Better double up on both the Ortho Tri Cyclen and condoms, ladies. If you get knocked up while you're still on your parents' plan, you're both literally and figuratively fucked.

http://jezebel.com/5932613/still-on-your-parents-insurance-great-just-dont-get-pregnant

In 2008, an estimated 2.8 million women ages 15 through 25 got pregnant, 12 percent of all those in this age group, according to researchers at the National Center for Health Statistics. (That is the most recent year for which there are pregnancy estimates.)
...
In some states, a pregnant young woman might qualify for Medicaid, the federal-state health-care program for low-income individuals, even if she lived at home with her parents, say experts. But when Wendy and her husband, Andy, investigated, they were told that eligibility would be based on their household income, which was too high to qualify for Medicaid.
...

The health-care overhaul provides assistance to some young women who become pregnant while on their parents’ plans. Under the law, preventive health benefits that are recommended by the U.S. Preventive Services Task Force, a federal agency, must be covered by new plans and by plans that have changed enough to lose their status of being grandfathered under the law. The recommended services include a range of screenings for pregnant women, including those for anemia, hepatitis B and Rh incompatibility.

In addition, starting this month, when a non-grandfathered health plan begins its new plan year, it must provide certain other women’s health services at no charge, including an annual well-woman visit, screening for gestational diabetes and breast-feeding support, supplies and counseling.

Starting in 2014, maternity and newborn care is one of 10 so-called essential health benefits that must be offered by all health plans in the individual and small-group markets, including those that are sold through the state-based health insurance exchanges that will be up and running then.

Large-group plans, however, are exempt from the requirement to provide the essential health benefits, now or in 2014.

http://m.washingtonpost.com/national/health-science/parents-insurance-covers-children-up-to-age-26--but-not-for-pregnancy/2012/08/06/2b59f160-6a2c-11e1-acc6-32fefc7ccd67_print.html

[notadmblnd]

1. if a a child becomes pregnant while on their parents policy, she will qualify for medicaid

just as many young girls who get pregnant now do. Why do you want to keep scaring people with your gloom and doom?

[ProSense]

2. Isn't it

"Why do you want to keep scaring people with your gloom and doom?"

...obvious?

[notadmblnd]

4. Yes, it is obvious

but it pisses me off that people come here pretending to be experts on the ACA while actually knowing less than I do about it. And I don't know much, but I do know that this is going to help many people, including members of my family who have never had health insurance their entire adult lives.

[dkf]

6. So you think parents and young women should be unaware of this situation and wander blindly into it?

It's a consideration in a cost benefit analysis. Geez.

People are going to have to examine their plans in depth now because there are choices. Before it was a case of take it or leave it but now there is a lot more to examine.

[notadmblnd]

8. I examine my plan every freaking year!

Once a year I am given an opportunity to make changes. In fact, I just went through it and turned it in.

Furthermore, everyone should review their policies at the least annually.

[dkf]

13. And do you think parents considering adding their adult daughter should look for pre-natal coverage?

[dkf]

3. In the WAPO case the family income was too large to qualify.

[notadmblnd]

5. Not true. There is absolutely no means testing of parents when a young woman gets pregnant and

applies for medicaid.

[dkf]

10. So you dispute Kaiser's report? This quote is an all 3 articles.

In some states, a pregnant young woman might qualify for Medicaid, the federal-state health-care program for low-income individuals, even if she lived at home with her parents, say experts. But when Wendy and her husband, Andy, investigated, they were told that eligibility would be based on their household income, which was too high to qualify for Medicaid.

http://www.kaiserhealthnews.org/features/insuring-your-health/2012/under-26-pregnancy-coverage-michelle-andrews-080712.aspx

Maybe you should tell them and the WAPO to issue a correction since you are more of an expert. Medicaid is a state by state situation so what is true in your state may not be true for all.

[notadmblnd]

12. Exactly, so you don't have to come here and spread your gloom and doom

because not everyone who is on their parents policy and gets pregnant are literally fucked.

[dkf]

14. But they could be. And do you want them to know beforehand?

Would you have preferred I not post this to prevent "doom and gloom" exactly at the time people need to start being aware of how this works?

How many parents are looking for this do you think? Would it even occur to them?

[notadmblnd]

15. You could have provided the info without the snarky "you're fucked"

Because they're not necessarily fucked. For one, there is the babies father. Girls don't just magically wake up pregnant and I'm really really tired of the guys getting off scott free.

The father is the person who should be billed for half the costs if a situation occurs where a 19- 26 yr old woman living with her parents get pregnant and her parents insurer doesn't cover the costs and medicaid wont cover the birth because the parents make too much $$$.

It would be interesting to know, how much parental income is too much income for this young woman to be denied medicaid.

[dkf]

17. Well you could be. Better to make the impact now than finding out the hard way.

This is decision time and this aspect deserves consideration for all the young women thinking they can get a great deal being on their parent's plans. For all we know there are 25 year olds employed and with health care thinking they can get ahead by dropping their own plan and getting on to mom or dad's plan. This is what happened to Joe Scarborough whose son decided the family plan was a great deal aka free. But he isn't a female who would be stuck if she got pregnant. Moreover you get the access of your parents plan but your bills are still your own.

More education is needed not less.

[notadmblnd]

18. yes, I will agree with you there, more education is needed

If the scenario which you cite is so god awful common that people are being forced into bankruptcy over their children's pregnancies, then I think that the parents recourse would be to drop the child from their insurance from policy and purchase one for the child on the ACA exchange where the child will be covered.

It does not have to be the horror story you present it as. You do not have to come here an scare the bejeesus out of people in an attempt to convince people that the ACA is a bad thing. It is not a bad thing.

[dkf]

19. Exactly right they should look at all options including Medicaid, the exchange, their family

And their own plan.

That is some heavy duty analysis and choices.

So if my post was doom and gloom and made anyone think then GOOD. I am happy.

[Mojorabbit]

20. IN a perfect world yes, but this isn't one and more often not the woman deals with it all. nt

[notadmblnd]

21. And she had even less options before the ACA

[Mojorabbit]

35. That is not the point is it? nt

[notadmblnd]

36. The thread is about the ACA

not how women over the years have had to deal alone when they've found out they were pregnant and the father was off to the next notch in his belt.

So yes, yes it is the point.

[Mojorabbit]

37. You were the one who brought up options as if women should be happy with what ever they

are granted in the ACA.

[notadmblnd]

38. And you just want to argue.

[Mojorabbit]

39. When someone does not agree with you it does not mean they want to argue.

In this case we are on a Discussion board where opinions are meant to be shared. Women should expect that their health care is taken care of in an insurance plan and that includes reproductive health.

[notadmblnd]

40. And the ACA does just that

There are several procedures and tests that are now absolutely free for women under the ACA. The info is posted somewhere here. In fact I think it is posted in this thread.

I disagree with the OP that a young woman who is on her parents policy is "fucked" because of Obama care if she becomes pregnant. It simply is not true. I managed to have a civil conversation with the OP here and managed bring it to a civil conclusion.

I get the impression that you want to talk about how women have struggled over health care on their own over the years and that you think (as the OP stated) that we're all still "fucked" even with Obamacare.

The ACA is not perfect, but it helps women immensely. If you disagree with that then it is simply because you refuse to accept the facts.

[Mojorabbit]

41. I live in a state that did not buy into the medicaid expansion.

I think a woman in the case described above might end up in a mess. I think a woman's complete reproductive health coverage should be available in all policies. There is no part of a man's health that is cut out. "Some procedures and tests" is not the same as comprehensive coverage. That is the point I am making. I have no problem accepting any facts. None at all.

[pnwmom]

26. What if she's living in a household with an income too high for Medicaid? n/t

[notadmblnd]

29. then I would think her parents should consider dropping her from their insurance

and buying into the Affordable Care Exchange on her behalf.

[pnwmom]

34. That is what I would do, yes. n/t

[kelliekat44]

7. But they already denied this benefit BEFORE the ACA was passed. That's one of the problems. nt

[notadmblnd]

9. her parents health insurer denied her, not medicaid.

Sorry, I thought you were posting to me.

[dkf]

11. No, she didn't qualify for Medicaid because the family income was too high.

Did you read any of the articles?

[dkf]

16. Yes and they obviously knew about it because they made provisions in the individual market.

But they didn't for group coverage which is where most get their insurance.

[ProSense]

22. The articles in the OP are from 2012. Still, Kaiser:

'A Basic Health Benefit'

The health-care overhaul provides assistance to some young women who become pregnant while on their parents' plans. Under the law, preventive health benefits that are recommended by the U.S. Preventive Services Task Force, a federal agency, must be covered by new plans and by plans that have changed enough to lose their status of being grandfathered under the law. The recommended services include a range of screenings for pregnant women, including those for anemia, hepatitis B and Rh incompatibility.

In addition, starting this month, when a non-grandfathered health plan begins its new plan year, it must provide certain other women's health services at no charge, including an annual well-woman visit, screening for gestational diabetes and breast-feeding support, supplies and counseling.

Starting in 2014, maternity and newborn care is one of 10 so-called essential health benefits that must be offered by all health plans in the individual and small-group markets, including those that are sold through the state-based health insurance exchanges that will be up and running then.

Also, the NWLC is challenging any attempt by employers to exclude coverage for pregnant dependents.

Nondiscrimination Protection in the Affordable Care Act: Section 1557

Section 1557 of the Affordable Care Act prohibits discrimination in health care programs on the basis of race, color, national origin, sex, sex stereotypes, gender identity, age, or disability. This is the first time that federal law has prohibited sex discrimination in health care. Health insurers, hospitals, the health insurance exchanges, and any other entities that receive federal funds are covered by this law. It became effective upon passage of the ACA.

Section 1557 gives the Department of Health and Human Services’ Office for Civil Rights the authority and obligation to investigate potential violations of the law and enforce this new civil rights guarantee.

The text of Section 1557

Except as otherwise provided for in this title (or an amendment made by this title), an individual shall not, on the ground prohibited under title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000d et seq.), title IX of the Education Amendments of 1972 (20 U.S.C. 1681 et seq.), the Age Discrimination Act of 1975 (42 U.S.C. 6101 et seq.), or section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 794), be excluded from participation in, be denied the benefits of, or be subjected to discrimination under, any health program or activity, any part of which is receiving Federal financial assistance, including credits, subsidies, or contracts of insurance, or under any program or activity that is administered by an Executive Agency or any entity established under this title (or amendments). The enforcement mechanisms provided for and available under such title VI, title IX, section 504, or such Age Discrimination Act shall apply for purposes of violations of this subsection.

Why do we need Section 1557?

Prior to passage of the ACA, no federal law provided comprehensive protection against sex discrimination in health care. The ACA has many provisions that address specific inequities in the health care marketplace—such as the failure to provide contraceptive coverage to women, the exclusion of maternity care from health insurance plans, and the lack of protection for nursing mothers in the workplace, among others. Section 1557, however, applies longstanding sex discrimination prohibitions to across the board and to all aspects of health care, including some not addressed explicitly by the ACA.

<...>

What does “sex discrimination” mean under Section 1557?

Section 1557 is similar to Title IX, which prohibits sex discrimination in education programs that receive federal financial assistance and other federal laws like Title VII, which prohibits discrimination in employment. Under Title IX and other civil rights laws, sex discrimination includes, but is not limited to, discrimination based on pregnancy, pregnancy-related conditions, marital or familial status, gender identity, and sex-stereotyping.

- more -

http://www.nwlc.org/resource/nondiscrimination-protection-affordable-care-act-section-1557

Advocacy Group Seeks To Force Employers To Give Pregnancy Coverage To Dependents
http://www.kaiserhealthnews.org/stories/2013/june/05/complaints-about-sexual-discrimination-on-daughters-pregnancy-benefits.aspx

This is another example of how employer-based health care sucks.

[dkf]

23. I came across this issue trying to find out how the under 26 coverage worked.

The media and the government have failed to properly educate people. I guess they think every American is going to call a navigator to get specific info? I am skeptical...

And why did I have to go back to 2012 articles? It's pathetic!!!

[ProSense]

24. Seriously,

"I came across this issue trying to find out how the under 26 coverage worked.

The media and the government have failed to properly educate people. I guess they think every American is going to call a navigator to get specific info? I am skeptical..."

...do you really believe parents of a dependent who becomes pregnant aren't going to research this information?

"And why did I have to go back to 2012 articles? It's pathetic!!!"

You didn't. There are articles as recently as August discussing this very issue.

Like I said, it's mostly a failure of some, not all, employer-based plans. Those on the exchanges will be covered.

[dkf]

25. They will research once it's too late and their daughter is pregnant.

Exactly the problem. You have hit it on the head.

[ProSense]

28. You're inventing a problem

"They will research once it's too late and their daughter is pregnant."

Are you expecting parents with daughters on their health plan to research the potential their daughters will become pregnant?

I mean, if a dependent daughter is married and actively trying to get pregnant, why woud they wait?

If a daughter is sexually active, married or otherwise, why would they wait?

The government can't force people to research.

[dkf]

30. It should be a consideration explained to a young woman making her choices.

She would know best if she is sexually active or not and what the odds are of getting pregnant.

[pnwmom]

27. If we had a functional Congress, this could easily get fixed. But as it is,

it's all too confusing .. . .

[dkf]

33. They apparently looked and declined to because it has a fix in the individual Market.

[haele]

31. We were lucky-our plan covered our daughter two years ago-

But it might have been because she was 19 at the time.
Haele

[dkf]

32. No it doesn't sound age dependent. You have a good plan or should I say a good employer.