NCL applauds federal funding for maternal health in 2022 appropriations

March 18, 2022

Media contact: National Consumers League –  Katie Brown, katie@nclnet.org, (202) 207-2832

Washington, DC— The National Consumers League applauds the passage of the 2022 omnibus appropriations act. The appropriations bill, signed into law, includes over $1 billion in federal funding to support critical maternal health provisions needed to address the nation’s alarming maternal mortality rates.

We are pleased that many provisions of the Black Maternal Health Momnibus Act of 2021 were included in the FY 2022 appropriations bill. The new law provides a significant increase in funding for the CDC’s safe motherhood & infant health programs. This additional support will help to identify drivers of maternal death rates in the states and expand evidence-based programs and interventions at hospitals and birthing facilities across the nation. The bill also includes a significant funding increase to the Maternal and Child Health Block Grant, which will assist state and local health entities in providing the essential health and social services that our most vulnerable birthing people and babies need.

Provisions from the Maternal Health Quality Improvement Act were also included in the fiscal year 2022 omnibus appropriations bill. These provisions provide funding that supports health professional schools to train future health care professionals about perceptions and biases in maternal health, which currently contribute to inequities in maternal health outcomes. In addition to racial bias, it is critical to invest in diversifying and expanding the perinatal workforce to include nurses, doulas, behavioral health professionals, and other practitioners. In a recent blog post, NCL Health Policy Associate Milena Berhane discusses the importance of diversifying the workforce and the negative impacts of racial bias on the quality of care for racial and ethnic minorities.

We recognize that perinatal suicides, which occur during pregnancy or up to one year postpartum, are a leading cause of maternal mortality in the United States. We are pleased that this appropriations act provides increased federal funding for maternal mental health programs. The additional funding will be critical in expanding access to community-based treatment and recovery services for pregnant people and new mothers who struggle with mental health or behavioral health conditions. The spending bill also funds additional necessary mental health resources, by increasing funding for the 24/7 maternal mental health hotline that is available to pregnant people and new mothers.

NCL applauds Congress for providing funding for critical maternal health provisions within the FY22 Omnibus bill. We will continue to advocate for the passage of additional maternal health provisions in future legislation and spending bills until we end the maternal mortality crisis in our nation.

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About the National Consumers League (NCL) 

The National Consumers League, founded in 1899, is America’s pioneer consumer organization. Our mission is to protect and promote social and economic justice for consumers and workers in the United States and abroad. For more information, visit www.nclnet.org.

Why we need more Black health professionals in the workforce

By NCL Health Policy Associate Milena Berhane

A lack of diversity in the health care workforce has been a persistent issue in the United States, posing significant implications to health equity, particularly for the Black or African American community.

An estimated five percent of physicians identify as Black, despite making up 13 percent of the U.S. population. A recent study utilizing U.S. Census Bureau information found that the proportion of Black physicians in the United States has only increased by four percent in more than a century — from 1900-2018. This study also reported that the percent of Black male physicians has remained relatively stagnant since 1940. Diversity issues also exist in other health care professions, with an estimated 7.8 percent of nurses, 3.8 percent of dentists, and 2.5 percent of physical therapists being Black.

The education, testing, application, and interviewing process required to pursue a career in health care is rigorous and costly. In addition to a four-year degree, candidates are also required to take standardized exams, pay expensive application fees, and pay for travel to interview. Most medical students expect to spend up to $10,000 for the application process. Once accepted to a health professional program, the tremendous monetary and time costs of schooling are immense obstacles for many. Medical school attendees accumulate an average $200,000 of student loans by the time they are finished with their programs.

Due to generations of systemic racism in our country, Black Americans are less resourced — financially and in terms of social capital — than their white counterparts. The rigorous process of applying to and remaining in health professional programs creates a pipeline that excludes disadvantaged students from the ability to pursue careers in clinical care.

The barriers to enter the workforce have further negative impact on communities and health equity. Black patients face a variety of issues that can influence their ability to access medical care, including medical mistrust caused by historical unethical medical mistreatment faced by Black Americans, dismissal of health concerns that Black patients express to health care providers, and others. Time and time again, Black patients have shared their experiences of medical providers ignoring their health concerns, and therefore being undertreated and going undiagnosed for their conditions. In addition, research indicates that Black patients report poorer patient-provider communication and shared decision-making. These issues lead to Black patients receiving lower quality care from medical providers, further worsening health conditions that could be treated.

Racial bias and a lack of culturally competent medical care in the healthcare system has led to poorer health outcomes for Black patients. Black Americans of all ages already face higher rates of hypertension, asthma, diabetes, and other health issues due to systemic racism and how it has affected the environments they live in, the food they have access to, their education prospects, income, etc. These inequities compiled with a culturally incompetent and bias medical system leaves Black Americans with little ability to receive proper medical treatment and improve their health and well-being. Although medical schools are attempting to teach the importance of culturally competent care, it is crucial that Black patients are also able to access healthcare providers that look like them and come from their communities.

Clearly, the current make up of racial diversity of the health care workforce has failed to keep up with the demographic shifts in the United States. Although public health efforts are important in addressing and improving health equity, inequities within the medical system must be addressed simultaneously. The COVID-19 pandemic has only highlighted and exacerbated health inequities. Increasing the amount of Black health professionals across the United States is a critical step in ensuring better health outcomes for Black patients and their overall well-being.

Happy 8th anniversary to the Affordable Care Act – National Consumers League

Janay JohnsonOn March 23, 2010, in landmark legislation, President Barack Obama signed the Patient Protection and Affordable Care Act (ACA) into law. For the first time, Americans joined the rest of the developed world in hopes the law would bring us closer to realizing a health system where quality, affordable healthcare is available for all, and not a luxury for the privileged few. This sweeping overhaul of our healthcare system was met with mixed emotions: Democrats felt that the work of generations to see universal health care provided was finally fulfilled; the Republican party called it “Obamacare and railed about its many ills.

In the years since that historic day, those partisan sentiments persist. But despite a roller coaster of triumphs and setbacks, the ACA has been a huge success; millions had access to health care and in regions where pent-up demand was particularly acute – rural and urban areas alike.

The early leaders of the National Consumers League – from Florence Kelley to Frances Perkins – strongly supported health care for all Americans, so Obamacare was a fulfillment of our earliest agenda. And Obamacare, despite efforts to destroy its protections is the law of the land. The way health care is accessed and delivered in this country has been has been forever changed—most would say for the better. The ACA ushered in a new era in which comprehensive health coverage is finally within reach for millions of Americans who had been forgotten for way too long. And so today, this eighth anniversary of President Obama putting pen to paper, we acknowledge the ways the ACA has improved our health system. And we have no intention of going back.

Before the ACA was passed, the health insurance landscape looked significantly different. One in four Americans either lacked insurance or was underinsured, sick patients could be turned down for coverage because of pre-existing conditions, plans could charge women more than men for no reason other than their gender, and the cost of insurance was outpacing  Americans’ incomes. In short, our health system was about as lawless as the Wild  West. With the passage of the ACA, sweeping reforms not only outlawed many of the predatory and exclusionary practices that permeated our health care system, but expanded access to coverage and established a list of ten basic services that all health plans were mandated to meet.

Today, more consumers than ever before can get the care they need when they need it. Because of the ACA, nearly 20 million more Americans have gained health insurance. One of the primary ways the ACA achieved this was through the expansion of Medicaid, which extended coverage to millions of previously uninsured low-income individuals. The ACA also permitted young adults to stay on their parents’ insurance until age 26. Perhaps one of the most popular signature features of the ACA is the 10 Essential Health Benefits, including contraception, maternity care, mental health services, prescription drug coverage, and other services that all plans are mandated to provide. Other benefits and consumer protections we can thank the ACA for include a ban on lifetime coverage limits; the abolition of the “gender rating” practice, which allowed plans to charge women more than men; cost-sharing subsidies to help low-income Americans afford their coverage; the elimination of out-of-pocket costs for preventive care services such as immunizations, contraception, and cancer screenings; and a guarantee that an individual cannot be denied coverage or charged more because of a pre-existing condition.

Now of course it’s no secret that the Affordable Care Act has taken a beating. Despite a myriad of unsuccessful attempts by the Republicans to repeal and replace the ACA since its inception, the Trump Administration has made it a point to use whatever regulatory options are available to dismantle the ACA in any way it can. Though tribal loyalty within Congress has intensified exponentially in recent years, it’s time to put partisan politics aside and put the well-being of the American people first. Is the Affordable Care Act perfect? No. Is there room for improvement? Of course. But rather than tearing it apart, Republicans and Democrats should come together and strategize on how we can work together to strengthen and improve the ACA to better serve everyone.

At the White House signing ceremony in 2010, President Obama said in reference to the passage of the ACA, ” Our presence here today is remarkable and improbable. It’s been easy at times to doubt our ability to do such a big thing, such a complicated thing, to wonder if there are limits to what we as a people can still achieve.  But today we are affirming that essential truth…that we are not a nation that scales back its aspirations. We are a nation that does what is hard, what is necessary, what is right. Here in this country, we shape our own destiny.” And so even in these topsy-turvy political times, when it may seem that the protections we hold most dear are under attack and the progress we have made is at risk of being undone, we must remember that when we stand together, anything is possible – no matter how big, complicated, or improbable. The power of the people has always been stronger than the people in power and we have shown, particularly in the efforts to protect the Affordable Care Act, just how powerful we are. It is this spirit that vitalized advocates and everyday citizens to demand something better from our healthcare system, this spirit that saw the Affordable Care Act through to fruition, and the same spirit that will embolden us to defend it in the days ahead. And while we will continue to be steadfast in the fight to protect our care, today, we take a moment to celebrate how Obamacare revolutionized America’s health care system, provided access to health care for millions of underserved Americans in need, and has shown how fundamental it is for a nation with America’s riches to provide health care to all.

The path to mental health reform – National Consumers League

By Stephanie Sperry, NCL health policy intern

Mental illness in the United States is a public health crisis. On March 7, 2018, the Center for American Progress hosted a discussion between Sacramento Mayor Darrell Steinberg and New York City First Lady Chirlane McCray, covering the efforts of cities and states on the path to mental health reform.

Mental illness is not limited by age, gender, race, or geographic location, and proposed cuts to Medicaid and the Affordable Care Act will severely limit treatment options for those in need. Research done by the National Institute of Mental Health showed that annually, 1 in 6 adults in the United States experience mental illness. In the absence of national leadership efforts and support on the mental health front, First Lady McCray pioneered the ThriveNYC framework in 2015 to initiate an agenda for mental health reform, while Mayor Steinberg set about to change the delivery of mental health services by authoring the California Mental Health Services Act (Proposition 63) in 2004.

ThriveNYC aims to “reduce the toll of mental illness, promote mental health, and protect New Yorkers’ resiliency, self-esteem, family strength, and joy.”  It was built on 6 guiding principles: changing the culture of mental health; acting early with interventions; closing treatment gaps with wider access to care; partnering with communities to create solutions; using data better to provide accurate information and tools to City agencies, treatment providers, and others; and strengthening the government’s ability to lead through expectations of accountability and responsibility. First Lady McCray gave examples of current efforts, including the incorporation of screening for maternal depression during physician visits and training 250,000 people in mental health first aid. She explained that early detection is valuable, because 50% of the time, symptoms of mental illness emerge by age 14, and 75% of the time by age 24.  Early treatment can greatly reduce the long-term adverse consequences of mental illness, while saving both time and money.

Sacramento Mayor Steinberg called mental health the “under-attended issue in our time and in our society.” After both the Community Mental Health Act, signed by President John F. Kennedy in 1963, and the Lanterman–Petris–Short (LPS) Act, signed by Governor Ronald Reagan in 1967, failed to deliver on their promises to address mental health for over 50 years, Steinberg took action. He was instrumental in the creation and passage of the California Mental Health Services Act (Proposition 63, 2004). This Act imposed a 1% tax on personal income more than $1 million, with revenue going into the “Mental Health Services Fund”. This Fund aims to support county mental health programs and monitor progress toward statewide goals, with an emphasis on prevention, early intervention, and the expansion of programs serving affected or at-risk individuals.

In addition to dedicated funding, technology has a unique part to play in strengthening mental health reform. Mayor Steinberg noted the innovative work of Mindstrong Health, which uses digital phenotyping to collect biomarker measurements from smartphone use to provide information about an individual’s mood, cognition, and behavior. This can deliver insights to patients and providers, helping to diagnose and manage mental illness by establishing a baseline and spotting and analyzing deviations from it.

The discussion between Mayor Steinberg and First Lady McCray was a fascinating snapshot into state and local efforts to tackle the monumental challenge that mental illness presents in society. The National Consumers League applauds these two local leaders – and their counterparts across the country – for launching initiatives to improve prevention, detection, and treatment of mental illness, and laying the groundwork for better mental health outcomes.

President’s Day: A time to celebrate two great men and modern medicine – National Consumers League

Happy President’s Day! Given who is currently sitting in the White House, let’s change the subject and celebrate modern medicine as it affected the two American Presidents we are celebrating this holiday. Reading the news this week about the flu virus, I was reminded about how lucky we are in 2017 to avoid the scourge of infectious disease that afflicted both Presidents George Washington and Abraham Lincoln, two of my favorite presidents and the two this holiday is named for. 

As the flu season is in full tilt and a deadly one this year, if I had a nickel for every person who said, “I don’t get a flu shot because I think it gives you the flu,” I’d be a millionaire. No, flu shots don’t make you sick; and though they say the flu shot this year is only 36 percent effective, I’ll take those odds. According to reports, an estimated 4,000 people have died this year. The vast majority haven’t been vaccinated.

A headline in The Washington Post this week was overly grim. The article was great but the headline was misleading, focusing on the 36 percent statistic.

Read deeper and you find that administering the flu shot in children younger than 9 offers much greater protection to them, reducing by more than half the risk of becoming so sick that they need to see a doctor. That data comes against the backdrop of at least 63 kids dying from flu since October 1. As in past winter flu seasons, about three-quarters of children who have died were not fully vaccinated, officials said. That is critically important information for parents! My headline would have read:

Flu shot provides unusually high protection to children this year

This tracks with history. A new analysis of seasonal flu deaths in U.S. children in the six seasons since the 2009 pandemic found that children ages 2 and younger are most at risk. Of the children who died during those years, less than a third had been vaccinated. In other words, vaccination gives your kids a much better chance of fighting the virus.

But back to my favorite presidents—George Washington and Abraham Lincoln. Washington would have lived longer—and Lincoln and his wife Mary Todd Lincoln would not have been so terribly broken by the deaths of their young children from typhoid fever—had they been living today. Now, thanks to modern medicine, we get a shot that protects us from typhoid fever. NCL history tracks similar tragedy. Florence Kelley, NCL’s first general secretary, wrote often about the deaths of her siblings in the late 1800s, calling them the “dark days of diphtheria.” Today we get a shot to prevent diphtheria.

George Washington, it turns out, suffered from a host of infectious diseases in his lifetime. “There are many points before and after the Revolutionary War when he could have died,” said Dr. Howard Markel, director of University of Michigan’s Center for the History of Medicine. “He was really quite ill, even when he was president.” Today, Washington would have had a preventive shot for diphtheria and taken antibiotics for the tonsillitis that likely killed him at the ripe old age of 67; his body was weakened by fending off infectious disease after disease.

So consumers, don’t let anyone tell you NOT to get the flu shot—and don’t believe the urban myth: it will NOT give you the flu. There’s nothing the shot will do but increase your odds—and those of your children—from succumbing to the virulent virus. The Presidents we celebrate this week would have relished this chance to stave off disease. Let’s appreciate all that they did for America and at the same time thank modern medicine for the leaps and bounds we’ve made in fighting deadly infectious diseases.

Women can’t be complacent about their Medicare choices – the cost is too high – National Consumers League

This post originally appeared at Huff Post.

With all the news and controversy surrounding the Affordable Care Act (ACA) enrollment period, it’s easy to lose sight of the fact that Medicare open enrollment is also in full swing from now through December 7. This is the time for retirees to decide whether they should remain on their current Medicare plan or switch to another.

Ideally, the process should entail assessing your medical needs for the coming year, reviewing the details of your current plan to make sure it covers what you’ll need going forward, and considering whether there’s a better plan that will provide the right coverage at the right price. But unfortunately, that’s not how it usually works. In fact, a new survey sponsored by WellCare Health Plans, called the Cost of Complacency, shows that only about a third of seniors comparison shop for a Medicare plan at all.

Those harmed the most by not doing so are women: 26 percent more women than men ages 65 and older report feeling burdened by the cost of healthcare. It’s no wonder; there are several reasons for this. Women live longer than men—by an average of about 7 years. Longevity should be good news, but coupled with the fact that women typically have lower incomes and fewer financial assets—and have more chronic conditions requiring medical care than men—women often spend those extra years in a precarious financial situation.

Given these realities, it’s critical that older women have healthcare coverage that will meet their medical needs—not threaten their financial health. That’s not to say that figuring out what you need and which plan will best serve you is easy. As the WellCare survey found, 29 percent more women than men find the process of reviewing and comparing plans painful and frustrating. But the stakes are too high for women to not engage in the critical process of ensuring they are getting coverage that will protect both their health and their finances.

The reason it’s important to review and reassess your plan each year—even if you’ve been satisfied with your past coverage—is that it likely won’t be the same in 2018. Most plans change every year and some of those changes can be significant. Your health also changes (inevitably with greater costs as you age), so it’s especially important to consider how your current health conditions and whether the plan you’re currently on will provide adequate coverage if you are likely to need more diagnostic tests, different drug regimens, or more health care visits.

The basic rules of reviewing your plan include determining out-of-pocket costs, which consist of your premium, deductible, and cost-sharing charges, whether they may be copayments or co-insurance. You should also make sure that the pharmacies, health care providers, and hospitals you use are covered by the plan’s network or—if they aren’t—decide that you’re willing to switch to those that are.

For women on traditional Medicare (Part A & B), it’s also important to understand the gaps and limitations of that coverage. For instance, if you currently have or have had cancer in the past, you should be aware that there is a lifetime limit to the amount of diagnostic testing Medicare will cover. With treatments now enabling people to live with cancer for years as a chronic disease, you can quickly hit that maximum if there’s a need for expensive annual tests such as PET-CT scans. If you reach the Part B cap, you could be looking at exorbitant out-of-pocket costs.

With older women having higher rates of cognitive impairments, such as memory loss and dementia as they age, the Medicare limits on services associated with those conditions can have a particularly negative impact. While Medicare covers assessments for cognitive and neurological decline, it does not help with related ongoing services including daily care, care management, and home companions who can be incredibly costly, especially if needed for an extended period of time.

There are also significant coverage gaps in cataract treatments and no coverage at all for corrective eye exams, hearing exams, hearing aids, or common dental work.

About half of all women fill some of these gaps by enrolling in private plans, such as a supplemental Medigap insurance policy or a Medicare Advantage Plan that provides both Part B coverage as well as additional benefits.

So, there’s a lot to consider and yes, it can be overwhelming, which is why you shouldn’t do it alone. But, as the Cost of Complacency survey showed, most women do try to power through the process on their own, which could be why so many give up on doing it altogether. Instead, get together with a friend, your spouse, child, or grandchild and look to do the following: 

  • Review your current plan’s paperwork, including benefits and any limitations;
  • If you have them, review your medical receipts from the year to determine how much money you spent, and on what services;
  • Create a priority list for a Medicare plan, including not just “must haves,” but also “might needs”;
  • Use the Medicare Plan Finder tool on Medicare.gov to research plans based on your needs. Also, access community resources, such as senior centers, the State Health Insurance Assistance Program (SHIP), or the toll-free numbers provided by the plan providers to ask questions; and
  • Don’t try to review everything in one day. Do a little bit each day until the December 7 deadline.
You still have time to review, compare, and choose a plan that will serve your health needs for the coming year! It may be one of the most important things you can do to protect your health and your financial wellbeing.

Make your health a priority: Enroll in Marketplace health insurance by the January 31 deadline – National Consumers League

There is considerable anxiety over the future of healthcare in the face of our new Administration. However, the most important thing that consumers can do right now to protect their health is to enroll in or change their Marketplace health insurance plan by the January 31, 2017 deadline.

Consumers can go to HealthCare.gov to find a plan that best fits their needs and budget.

Why is having health insurance important?

  • It protects you and your family from unexpected medical costs. No one plans to get sick or hurt, but health insurance gives you important financial protection, just in case.
  • Marketplace health insurance gives you access to essential health benefits (like emergency services, maternity and newborn care, and prescription drugs) and preventive health services (like vaccines and screening tests) at no cost to you.
  • Marketplace plans may be more affordable than you think. About 85 percent of Marketplace consumers qualify for tax credits to assist with costs. At HealthCare.gov, you can find out if you qualify for financial help with your premium costs.

Contact HealthCare.gov’s Marketplace Call Center toll-free at 1-800-318-2596 for assistance with enrolling. If you have more questions about health insurance, we encourage you to visit MyHealthPlan.Guide, a joint project of NCL and America’s Health Insurance Plans, which provides helpful tips about choosing and using your health insurance plan.

Don’t miss out on your chance to get covered–enroll by the January 31 deadline. Make your health a priority–you owe it to yourself!

Preventive care benefits: Your health plan’s best kept secret – National Consumers League

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To those who may question the necessity of health insurance, I have two words for you: Preventive care. Seven out of ten deaths among Americans each year are from chronic diseases, many of which are preventable. Preventive health services like physicals, immunizations and other screenings can help find health problems early, when the chances for treatment and cure are better, or even prevent health problems before they start. 

Preventive health services are covered under all health insurance plans with no additional out-of-pocket costs when provided by in-network providers. Your health insurance plan may cover even more services that cost you nothing – to find out more, be sure to contact your health plan.

Unfortunately, many consumers with health insurance don’t take advantage of these services – simply because they don’t know their insurance covers it.  That’s a problem we’re working hard to resolve.

Below we list some of the preventive care benefits available through your health plan: 

For adults:

Immunizations (Vaccines)

It is important for adults to stay up to date on their immunizations.  They can save your life and save your health.  Through your health plan, vaccines for diseases such as chicken pox, tetanus, diphtheria, and pertussis, hepatitis A & B, and the flu are all covered. 

Depression screenings

Too many people suffer from mental health conditions, such as depression, and the consequences can be devastating on individuals and families alike. Taking a depression screening is one of the most efficient and effective ways to determine whether you are experiencing symptoms of depression and get you on the path to treatment. Depression screenings are fully covered by your health plan. 

Cancer screenings

Nearly everyone has felt the impact of cancer – either themselves or a friend or loved one.  Screenings are one of the most powerful weapons against cancer. When many cancers are found early, chances of survival increase exponentially. Important preventive cancer screenings include cervical cancer screening, breast cancer mammography screening, and colorectal cancer screening. Lung cancer screening is also covered for adults aged 55-80 who are current smokers or have quit smoking in the last 15 years. 

For women:

Well-woman visits

Well-woman visits are key to women’s health and help identify health concerns before they become life-threatening. These visits usually include your annual physical examination, as well as any necessary screenings (such as pap tests, blood pressure and cholesterol screenings), evaluations, counseling, and immunizations based on your age and risk factors. 

Services for pregnant women or women who may become pregnant

In addition to the preventive services available to all women, there is also a list of services available for mothers-to-be. Breastfeeding support and counseling, gestational diabetes screenings, anemia screenings, and even folic acid supplements for women who may become pregnant are all covered under your health plan – at no additional cost to you. 

For children:

Autism screenings

The American Academy of Pediatrics recommends that children are screened for autism at their 18- and 24-month well-child visits. This type of screening can quickly identify children with developmental and behavioral challenges when early treatment may be most effective. 

Vision screenings

Good vision is essential to a child’s development, success, and overall well-being. Their vision should be checked when they are first born, while they are a baby, and through their preschool and school years. If problems with a child’s vision are not detected early, their vision may become limited in ways that cannot be rectified later in life. And it can also affect school performance and learning.  But with early detection, it is usually possible to treat vision problems effectively. Thankfully, vision screenings for all children are covered through your health plan. 

Be on the lookout for new resources from the National Consumers League (NCL) and America’s Health Insurance Plans (AHIP) to help consumers get the most out of their health insurance benefits.

What you need to know about your health insurance benefits – National Consumers League

stethoscope_heart_92.jpgIt’s no secret that choosing a health insurance plan isn’t as easy as ordering at a restaurant. Even after purchasing a plan, actually understanding what exactly you’ve purchased is yet another stressful task. Health insurance can confuse even the savviest consumers. Read on for a few tips every consumer should know when it comes to health insurance benefits.


Your health plan most likely offers essential health benefits.

All plans purchased through the Affordable Care Act (ACA) marketplace and the majority of health plans provided by employers are required to provide a core group of medical services called essential health benefits. These services include:

  • Ambulatory patient services
  • Emergency services
  • Hospitalization
  • Pregnancy, maternity, and newborn care 
  • Mental health and substance use disorder services, including behavioral health treatment
  • Prescription drugs
  • Rehabilitative and habilitative services and devices
  • Laboratory services
  • Preventive and wellness services and chronic disease management
  • Pediatric services, including oral and vision care

To find the full list of services your plan covers and how much those services cost, check your Summary of Benefits and Coverage (SBC). You can request a copy of this document through your insurance company or access it via your online account through your insurance provider’s website.

Staying in network will save you money.

Visits to health care providers or facilities within your plan’s network are generally much cheaper than visits to out-of-network providers or facilities. The type of insurance policy you have plays a role in who participates in your plan’s network and how much you will pay if you choose to visit an out-of-network provider not covered by your plan. For example, HMO (Health Maintenance Organization) plans require you to select one primary care physician who will coordinate all of your health care services. With this plan, out-of-network providers are typically not covered at all, expect for true medical emergencies.

On the other hand, PPO (Preferred Provider Organization) plans allow you to visit any provider or specialist, in-network or out-of-network, and without a referral. Though your PPO plan may cover your out-of-network visit, you will pay more out-of-pocket for those services. Regardless of the type of plan you enroll in, be mindful of the providers in your network, as it can have a huge effect on your out-of-pocket costs.

All qualified health plans have cost-sharing limits.

All qualified health plans have an out-of-pocket maximum, which is the most you have to pay personally for covered services over the course of a year. All the money you pay for your deductible, coinsurance, and copays (but not premiums) goes toward your out-of-pocket maximum. Once you reach this limit, your insurance plan pays 100 percent for all covered medical services. Understanding how all potential out-of-pocket costs work together can be a little complicated, so here’s an example:

  • Suppose you are in a serious accident and have acquired $30,000 in medical expenses. Your health insurance plan offers a $2,000 deductible, 20 percent coinsurance, and a $5,000 out-of-pocket maximum for the year.
  • You would first be responsible for paying your deductible ($2,000).
  • After paying your deductible, you are responsible for your 20 percent coinsurance on the remaining $28,000 until you reach your out-of-pocket maximum.
  • Since 20 percent of $28,000 is $5,600, you would only be responsible for paying an additional $3,000 since your out-of-pocket maximum is $5,000. Your insurance plan would then pay 100 percent for all covered medical services thereafter.   

Be on the lookout for new resources from the National Consumers League (NCL) and America’s Health Insurance Plans (AHIP) to help consumers choose and get the most out of their health insurance benefits.

Five commonly asked consumer health insurance questions – National Consumers League

doctor_patient_crop.jpgWith the Affordable Care Act (ACA) becoming law in 2010, more Americans now have access to health care coverage than ever before. However, many consumers are still puzzled about how to select a plan, what services are covered, or why they need health insurance altogether. If health insurance talk leaves you disillusioned or just plain confused, don’t give up. Below, we answer five of the most commonly asked consumer questions about health insurance. 

Why do I need health insurance?

It is in your best interest to have some form of health insurance. Why, you ask?

  • To protect your health
    While you may seem perfectly healthy now, sudden injuries or illnesses can occur in an instant. Without health insurance, you could be faced with thousands of dollars in medical costs, which could pose a significant financial burden well into the future. With health insurance, you also have access to preventive services such as physicals, immunizations, and other screenings that can help prevent diseases and identify problems earlier when they are easier to treat.
  • It’s required by law  
    Under the ACA, individuals are required to have health insurance (unless you qualify for an exemption). If you choose not to enroll, you will have to pay a tax penalty. 

How do I know what type of insurance plan is right for me and my family?

When shopping for a health insurance plan, here are some things to take into consideration:

  • Premiums: Each health insurance plan has a monthly premium that you must pay to maintain your coverage.  
  • Coverage/access to providers: Every plan has a different set of services, prescription drugs, and doctors that it agrees to cover. Every plan also uses a specific network of hospitals and health care providers to facilitate your care. Before choosing a plan, check that the services and prescription drugs you need are covered, and ensure that your current providers are within your plan’s network to avoid incurring additional costs down the line. 
  • Out-of-pocket costs: Out-of-pocket costs are health care expenses  you must pay yourself and that are not reimbursed by your insurance plan.

 Copayment, deductibles, coinsurance … What’s the difference?

  • A copayment or “copay” is a fixed amount ($10, for example) that you pay each time you visit a health care provider or fill a prescription.
  • A deductible is the amount you are responsible for paying for covered medical services before your health insurance plan starts to pay for covered medical expenses.
  • Coinsurance is usually a percentage of a total bill that you are responsible for paying after you’ve paid your deductible (for example, you pay 20 percent and your plan pays 80 percent). 

What is a health savings account, and what can I use those funds for?                                                                         

Health savings accounts (HSA) allow you to deposit pre-tax funds to pay for qualified medical expenses. They are typically combined with qualifying high-deductible health plans (HDHP). While HSA funds cannot be used to pay for monthly premiums, HSA-eligible HDHPs are attractive to many consumers because the premiums are generally lower. HSA funds can be used as needed to pay for prescription drug costs and fees such as copays, deductibles, and coinsurance. Learn more about health savings accounts here.

If my insurance company denies coverage for a service, is there anything I can do? 

If your insurance company does not authorize payment for a medical service, you have the right to appeal that decision. Before sending an appeal, carefully review your health coverage and the correspondence from your insurance company. Have copies of your medical records, letters from your providers, and any other pertinent information that supports your appeal. If your plan still denies payment of your claim after your initial appeal, you may opt for an external review conducted by an independent third party.

To answer questions like these, the National Consumers League (NCL) and America’s Health Insurance Plans (AHIP) are teaming up to provide consumers with even more helpful information about how to choose and use health insurance benefits.