New free health benefits start for women this week

By Deborah Kotz, Globe Staff

Affordable Care Act provisions that go into effect on Wednesday mandate that insurance providers must cover a wide array of preventive health services aimed at women, without any co-payments charged to patients. While many of these services, such as domestic violence screening and HIV testing, are already covered by health plans in the state, others -- including breast pumps for nursing mothers -- are not.

Co-pays will also be eliminated for many varieties of birth control pills, but not all brands. I currently pay about $35 per month for my generic brand of oral contraceptives. I recently received a letter from my insurance company that I could get my prescription for free if I switched to one of 10 different brands that were on their list, which I’m considering doing.

“These aren’t actually free services; insurance companies must reimburse physicians for them, which is reflected in premiums, but there will be no upfront cost-sharing by the patient,” said Dr. Paula Johnson, chief of the Division of Women’s Health at Brigham and Women’s Hospital, who served on an expert panel that recommended to the government which women’s health services should be covered. “It’s been pretty clear that co-pays can be barriers to receiving high-quality care, especially for low-income women.”

She said an estimated 1.2 million women in Massachusetts will benefit from the new rules.

Here are some of the biggest changes women can expect on or after August 1. For many, these changes won’t take effect until they renew their health coverage for the upcoming year.

1. Contraception without co-pays. Insurance providers must cover all forms of female contraception including sterilization, intrauterine devices (IUDs), and oral contraceptives without any co-payments. “The intent is for all available methods to be covered,” said Johnson. But health plans can decide which specific birth control pills, hormonal implants, and IUDs they plan to cover fully, so women may need to switch from their preferred method to get the cost savings.

What’s still uncertain is whether certain health plans affiliated with religious instititutions such as Catholic hospitals will be able to opt out of this provision.

2. Free breastfeeding support, supplies, and counseling. “The major intent is to have breastfeeding supplies covered like breast pumps,” said Johnson, to help women maintain nursing even after they return to work. A visit with a lactation consultant would also fall under this provision.

3. Well-woman visits. Women won’t have any co-pays for annual visits to their primary care provider as well as to their gynecologist. Some women go for one annual physicial, while others see two doctors for primary care, which is the reason for specifying full coverage for all well visits. “The idea here is that women’s primary care tends to be fragmented,” said Johnson, “and we wanted to support the full array of care.”

4. Screening for gestational diabetes earlier in pregnancy. Pregnant women will no longer have to pay extra to get screened for gestationtal diabetes during the second half of their pregnancies. The provision will also cover testing for high-risk women during their first prenatal visit in an effort to catch diabetes earlier.

5. Human papillomavirus (HPV) testing. The cervical-cancer-causing HPV virus has been traditionally detected indirectly via Pap smears, but those screens sometimes miss HPV. The health care law will mandate that women with negative Pap smears will have full coverage for a specific HPV DNA test beginning at age 30, once every three years. “This is a new technology and if women opt for this test, they are often asked to pay for it,” said Johnson. Now, they no longer will.