FACT SHEET
Why the Affordable Care Act Matters for
Women: Ensuring Affordability and Choice
in the Insurance Marketplace
OCTOBER 2015
Under the Affordable Care Act (ACA), rules and protections have been implemented to
reform the private health insurance market – including employer-sponsored plans – so it
better meets the needs of women and families. Already, the ACA has helped make coverage
more affordable and improved benefits. Thanks to the law, women and families now have
access to the information they need to make accurate comparisons of their plan options and
understand how their coverage will work once they are enrolled.
More Affordable Premiums
The ACA has established critical protections to stabilize private health insurance costs and
level the playing field for women.
 The ACA has put in place important protections to keep premiums in check. Under
these new rules, women and families can be confident that their insurance premiums
will no longer be inflated to support inefficient administrative practices or excessive
profits.
 The “80:20” Medical Loss Ratio rules require insurers to spend at least 80 percent of
premium dollars (85 percent for large group insurance) on health care services or
quality improvements. If they fail to do so, consumers get money back.
 Most individual and small group health plans are required to publicly report and
justify unreasonable rate increases. Independent experts scrutinize any rate
increases that are deemed unreasonable (rate increases of 10 percent or more) and
states are encouraged to reject excessive rate hikes.
 Most individual and small group health plans cannot charge women higher
premiums just for being female. In addition, these plans are no longer allowed to
charge higher premiums based on an enrollee’s health status or medical history.
 Eligible lower-income women and families can access tax credits and cost-sharing
reductions that help them afford health insurance sold in the marketplace.
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Better Benefits
The ACA requires private health insurance plans to meet women’s health care needs.
 For the first time in history, gender discrimination is prohibited in many health care
programs because the ACA prohibits all health programs and activities receiving
federal funds (including tax credits, subsidies and contracts) from discriminating
against women and other protected classes. For example, any insurance companies
receiving federal funds are prohibited from discriminating against women when
defining and administering benefit packages.
 The ACA makes it easier for women and
families to stay healthy and avoid high
health care bills down the road by requiring
most health plans to cover a wide array of
preventive services – including
contraception, mammograms and cervical
cancer screenings – without any cost-sharing
(i.e., no deductibles, copays or co-insurance).
Eligible lower-income women
and families can access tax
credits and cost-sharing
reductions that help them
afford health insurance sold in
the marketplace.
 The ACA prohibits most plans from
requiring women seeking OB/GYN care to
receive pre-authorization or a referral, saving women time and money. It also requires
plans sold in the marketplace to contract with essential community providers –
particularly family planning providers, HIV/AIDS providers, federally qualified health
centers, Indian health care providers and hospitals that serve medically under-served
and low-income populations – where many women currently receive quality care.
 The ACA requires individual and small employer health plans to cover a core set of
essential health benefits, including maternity care. While states have flexibility in
defining the specific contents of this essential health benefits package, the final
package must take into account the needs of women and children.
 The ACA prohibits health plans from denying coverage to an individual because she or
he has a pre-existing condition.
More Reliable Coverage
The ACA built in critical protections so women and families can feel confident that their
health insurance will be there when they need it most.
 The ACA protects women and families from significant financial hardship and stress
by prohibiting health insurers and plans from rescinding enrollees’ coverage when
they get sick.
 The ACA prohibits insurers from imposing lifetime dollar-value caps on coverage.
Annual dollar-value caps on coverage are now also illegal. Thanks to this provision, if
women have chronic conditions like diabetes or suffer from catastrophic illnesses or
injuries, health plans are not allowed to cut off coverage simply because of expensive
claims accumulated over the course of their lifetimes or plan years.
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 The ACA gives consumers the right to appeal adverse benefit decisions through an
internal process and to an outside, independent decision maker. Women and families
now have access to a fair system for recourse if they are denied benefits their health
plans offer.
Better Information
The ACA provides women and families access to standardized, easy-to-understand
information about health plans when they are comparing plan options.
 Under the law, all private health plans are required to provide a uniform, clear
summary of benefits and coverage (SBC) to all enrollees and to those shopping for
coverage. The SBC must:
 Clearly show a health plan’s deductible, limits, exclusions on benefits, and referral
requirements, as well as cost-sharing responsibilities for a variety of common
medical events, such as doctor visits, lab tests, prescription drugs, maternity care
and hospitalizations.
 Give examples of how the health plan may cover medical care in different situations
(such as pregnancy or managing diabetes), so that women can get a sense of how
much insurance coverage they and their families can expect to receive from different
plans.
 Women and families seeking coverage now have access to the marketplace, a one-stopshop for health insurance where they can find unbiased information on different plan
options. The marketplace helps women and families choose a plan based on the things
that matter to them – such as premiums and cost-sharing requirements, quality,
provider network, prescription drug coverage and scope of benefits.
The National Partnership for Women & Families is a nonprofit, nonpartisan advocacy group dedicated to promoting fairness in the workplace, access to quality health care and
policies that help women and men meet the dual demands of work and family. More information is available at www.NationalPartnership.org.
© 2015 National Partnership for Women & Families. All rights reserved.
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