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Guide to women’s health insurance in 2022

Learn how individual health insurance plans cover women's healthcare services, including maternity, contraception and abortion

Women’s health coverage

For women in the U.S., access to affordable coverage in the individual health insurance market has improved markedly over the past decade – due in large part to coverage improvements and consumer protections delivered by the Affordable Care Act.

Prior to the ACA’s implementation – largely starting in 2014 – women faced many barriers to coverage:

  • Previously, more than half of individual plans charged higher premiums for a 40-year-old female non-smoker than for a 40-year-old male smoker– for the exact same coverage.
  • More than 90% of individual health plans didn’t provide any routine maternity benefits.
  • In all but five states, being pregnant was a pre-existing condition that prevented a woman from purchasing individual health insurance.
  • Many individual health plans offered no contraceptive coverage.
  • Coverage for women’s preventive care varied considerably from one state to another.

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We hope you’ll use this guide to get a clearer understanding of how coverage has improved – and what you should expect for coverage of women’s healthcare when you’re selecting a health plan.
Legal and policy landscape for women's health coverage

Preventive care for women under the ACA

Prior to implementation of the Affordable Care Act, coverage of women’s preventive care varied considerable from state to state. But beginning in August 2012, all health plans (other than grandfathered health plans) were required to provide coverage for certain women-specific categories of preventive care:

  • Well-woman visits
  • Gestational diabetes sceening
  • HPV testing
  • Screening and counseling for domestic violence
  • HIV testing and counseling for sexually transmitted infections
  • Breastfeeding supplies
  • Contraception and family planning counseling

(Note that additional preventive care mandates, including preventive care for children and all adults as well as additional woman-specific preventive care, took effect in 2014.)

 

Coverage of women’s healthcare services

Coverage of maternity care

Prior to 2014, just 12% of individual-market health plans included maternity benefits. But the Affordable Care Act has been a game-changer. Maternity care is one of the essential health benefits that must be included on all individual and small-group policies.

That means that an expectant parent can now obtain coverage in every state during open enrollment or during a special enrollment period triggered by a qualifying event. And women are no longer charged higher premiums than men, despite the fact that every new major medical health policy includes maternity coverage.

Coverage of infertility treatments

Treatment for infertility is not one of the Affordable Care Act’s essential benefits – and coverage for infertility treatment is not mandated by the ACA or any other federal law. But some states have regulations that go beyond the minimum requirements laid out by the federal government with their own laws, regulations, and mandates.

These state rules only apply to state-regulated plans, which include health plans that individuals and businesses purchase from an insurance company. But self-insured employer-sponsored health plans are not subject to state insurance rules.

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Coverage of abortion

Abortion coverage is neither required nor banned under the ACA. But federal funds cannot be used to pay for abortion unless the situation involves rape, incest, or danger to the mother’s life. Coverage for other abortions varies considerably from one health plan to another.

Coverage of contraception

The Affordable Care Act improved access to highly effective, long-term contraceptives, without a cost barrier. Under the ACA, health policies that took effect on or after August 1, 2012 are required to cover — with no cost-sharing — at least one version of each FDA-approved contraceptive method for women. This includes sterilization, IUDs, and implants, which often had considerable up-front costs prior to the ACA.

Recommended reading:

Recent news

Access to women’s health care services was greatly expanded under the ACA. This was due not just to the ACA’s coverage mandates (for things like preventive care and maternity care), but also to the fact that the ACA resulted in far more women having health coverage. Medicaid expansion, the employer mandate, and access to subsidized coverage in the health insurance exchange/marketplace have all played a role in this.

But women’s health coverage and care continue to be controversial topics, and the rules continue to evolve over time.

Frequently asked questions about women's health coverage

Does the ACA require infertility treatment to be covered by health insurance?

Infertility treatment is not an essential health benefit under the ACA. However, 18 states have laws that require at least some coverage for infertility treatment on state-regulated health plans (which include health plans that individuals and businesses purchase from an insurance company).

Is contraception covered by health insurance?

Under the ACA’s rules, health plans effective on or after August 1, 2012 are required to provide all FDA-approved contraceptive methods for women, including sterilization, with no cost-sharing. This means that at least one version of every type of contraceptive is covered at no cost to a patient.

How can I find a health plan that covers maternity care?

The ACA mandates that maternity coverage is included on all ACA-compliant health plans nationwide.

Thanks to the ACA, being pregnant is no longer considered a pre-existing condition, which means pregnant women (and expectant fathers) can buy health insurance in the individual market in every state — assuming they are applying during open enrollment or have a qualifying event that allows them to enroll.

Do ACA health plans coverage abortion?

Whether your ACA plan covers abortion depends on the state where you live. In more than half of the states, health plans sold through the marketplace are not allowed to cover abortions except for circumstances involving rape, incest, or the mother’s life being in danger. At the same time, six states require all state-regulated health plans to cover abortion services.

Would ACA subsidies lower your health insurance premiums?

Use our 2022 subsidy calculator to see if you’re eligible for ACA premium subsidies – and your potential savings if you qualify.

Obamacare subsidy calculator *

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Add ages of other family members to be insured.

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Include yourself, your spouse, and children claimed as dependents on your taxes.

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Modified Adjusted Gross Income (MAGI)

For most taxpayers, your MAGI is close to AGI (Line 7 of your Form 1040 in 2018, and Line 8b in 2019).

Estimated annual subsidy

Provide information above to get an estimate.

* This tool provides ACA premium subsidy estimates based on your household income. healthinsurance.org does not collect or store any personal information from individuals using our subsidy calculator.

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