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What role does gender play in determining health insurance coverage?

Dr. Michael Roizen, MD
Internal Medicine

When does gender not play a role? It’s unfortunate, but true. And in this case (unlike Ladies’ Nights at clubs or bars), the ladies get the short end of the stick (but not for long)! The Patient Protection and Affordable Care Act has attempted to make it easier for all the ladies. For example, prior to the passage of the Affordable Care Act, many women had to get a referral just to see an Obstetrician-Gynecologist (OB-GYN). Now, women can choose any doctor they want without a referral.

Women also were charged more for insurance coverage simply because they were women. In some cases, a young woman could be charged 150% more than a man for the same coverage. (Women typically use more services because they get pregnant. Despite what you read in Enquiring Minds Want to Know, men typically cannot carry a baby.) But now, thanks to the new law, starting in 2014 insurance companies can’t gouge women simply because they’re women.

Read the fine print of your plan carefully to figure out all the nitty gritty details related to gender. For example, make sure you know exactly what happens if you, your wife, or your partner gets pregnant. You may need to invest in a good set of magnifying glasses to read it. Good luck!

Each gender has specific medical concerns and, therefore, gender plays a significant role in determining health care coverage and costs. A woman may be concerned with reproductive health and prenatal care if pregnancy is a possibility. A woman must also be concerned with conditions relating to cervical, ovarian, or breast cancers. A man will be concerned with prostate and testicular health, including erectile dysfunction. Men have higher risk for certain coronary diseases and earlier mortality. For both genders, it is important to ensure that the proper benefits will help you with preventative as well as curative care.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.