Although the overall rate of insurance coverage in Massachusetts before passage of the legislation exceeded 90 percent, since enactment, numerous subgroups of women have experienced substantial gains in coverage. In particularly, ethnic and racial minorities, low-income women, women without dependent children, and nonelderly women aged 50 to 64 years have experienced substantial gains in coverage, such that coverage is nearly universal for these subgroups of women (Long et al., 2010).
The preventive services benefits for women that plans must offer to be considered to have minimum creditable coverage are based on the recommendations for adults issued by the Massachusetts Health Quality Partners (MHQP) and other nationally recognized guidelines (Hyams and Cohen, 2010; MHQP, 2007). MHQP recommendations closely mirror those of the USPSTF but also include the coverage of preventive services such as counseling for preconception and menopause management and treatment for menopause.
According to the ACA, the new coverage rules for private plans in Massachusetts will be subject to the requirements of Section 2713, although the coverage may be broader than that included in the state law.4 In addition, the Chapter 58 rules state that plans must cover at least three preventive visits without applying the costs for those visits to the deductible (but copayments may exist) and require that contraceptive services and supplies be covered as preventive services without cost sharing.
Private Insurance Coverage Practices
Detailed information on the coverage and benefits provided by private insurance plans and employers and on the scope of the preventive benefits that they cover is often proprietary and difficult to obtain. This information is enormously complex, and details about the coverage provided differ considerably from plan to plan and employer to employer. Although periodic surveys of employers of the health care benefits that they cover and reviews of documents that summarize the plans are performed, most surveys and reviews look at classes of services rather than the actual specific benefits provided.
In addition, research on this topic suffers from other limitations. The research is often conducted by researchers who are either funded by or who are employees of health plans or employer groups; the response rates for these surveys are usually low; and the respondents, who are typically employers, may not know the specific details about benefit coverage included
4 Grandfathered plans, including those sold through the Commonwealth Connector, will not be subject to the new requirements unless and until they lose the grandfathered status discussed earlier.