So here it is: the WomenÃ¢â‚¬â„¢s Health scoop on all things ObamaCareÃ¢â‚¬”to help you figure out which plan you need, how much youÃ¢â‚¬â„¢ll be paying, and why you need maternity care (even if you never want kids).
Your Biggest Questions:
1. Why are so many health insurance plans being cancelled, despite the promise that Ã¢â‚¬Å“If you like your plan, you can keep itÃ¢â‚¬Â?
2. I have employer-provided insurance. Does this affect me?
3. WhatÃ¢â‚¬â„¢s the deal with HealthCare.gov? Why so glitchy?
4. If I want to purchase a plan through ObamaCare, can I skip HealthCare.gov altogether?
5. But I donÃ¢â‚¬â„¢t want health insurance. Are there any options for me?
6. IÃ¢â‚¬â„¢m entering the exchange. What do I need to know?
7. Am I eligible for subsidies?
8. What happens if not enough young people sign up?
9. IÃ¢â‚¬â„¢ve heard that some employers are refusing to offer contraception. WhatÃ¢â‚¬â„¢s the deal?
10. Why does everyone have to be covered for maternity care?
Why are so many health insurance plans being cancelled, despite the promise that Ã¢â‚¬Å“If you like your plan, you can keep itÃ¢â‚¬Â?
WeÃ¢â‚¬â„¢ve all heard that sound byte a tonÃ¢â‚¬”and we, too, have wondered: WTF? Barring a speech from the President, we may never know why he harped so much on keeping preexisting plans. But hereÃ¢â‚¬â„¢s what we do know: If you like your planÃ¢â‚¬”and it also happens to meet the new coverage criteria (see the section on Ã¢â‚¬Å“essential benefitsÃ¢â‚¬Â under Ã¢â‚¬Å“Why does everyone have to be covered for maternity care?Ã¢â‚¬Â)Ã¢â‚¬”you can keep it.
Or, if your plan hasnÃ¢â‚¬â„¢t changed since March 2010, when the Affordable Care Act was passed, you, too, can retain your coverage, since it will be Ã¢â‚¬Å“grandfatheredÃ¢â‚¬Â in to the new insurance regime. Ã¢â‚¬Å“This is the Ã¢â‚¬Ëœkeep your plan if you like itÃ¢â‚¬â„¢ line,Ã¢â‚¬Â says Susan Wood, Ph.D., an associate professor of health policy at George Washington University. Ã¢â‚¬Å“If plans never changed from the time of the law, then they donÃ¢â‚¬â„¢t have to change.Ã¢â‚¬Â
Salganicoff adds: Ã¢â‚¬Å“If youÃ¢â‚¬â„¢re on an employer plan, you can keep your planÃ¢â‚¬”any insurance that [large] employers provide is considered credible coverage.Ã¢â‚¬Â
Problem is, few plans on the individual marketÃ¢â‚¬”the policies that people without employer coverage buyÃ¢â‚¬”fit the ObamaCare standards (for example, most donÃ¢â‚¬â„¢t cover maternity care; more on that later). And few plans have stayed exactly as they were when the new legislation was implemented. Ã¢â‚¬Å“There is a tremendous amount of turnaround on the individual insurance market year to year,Ã¢â‚¬Â says Salganicoff. So, Wood explains, Ã¢â‚¬Å“Any of them that do change have to fall under the new rules. ThatÃ¢â‚¬â„¢s why people are getting these [cancellation] notices.Ã¢â‚¬Â
This misunderstandingÃ¢â‚¬”or miscommunicationÃ¢â‚¬”is the reason President Obama recently decided to let insurers reinstate canceled plans for another year. The catch: Insurers can opt outÃ¢â‚¬”meaning your plan may still be canceled if your carrier so chooses. And, keep in mind, these policies are only available to the people who already had themÃ¢â‚¬”if you were uninsured before the marketplace opened, you canÃ¢â‚¬â„¢t purchase one of these non-compliant plans now.
All of this is confusing (and frustrating), sure, but there is an upshot: If your current insurance is being canned, youÃ¢â‚¬â„¢ll also be gaining new protections, like guaranteed coverage for hospitalizations, prescription meds, and maternity care.
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I have employer-provided insurance. Does this affect me?
Probably not. The people receiving the nixed-policy notices were primarily consumers on the individual marketÃ¢â‚¬”which, again, means people not eligible for workplace coverage or Medicaid. Some folks who work for small companiesÃ¢â‚¬”those with fewer than 50 employeesÃ¢â‚¬”are also being told their plans are disappearing.
That said, if your workplace policy is unaffordableÃ¢â‚¬”meaning your premiums exceed 9.5 percent of your incomeÃ¢â‚¬”you can seek alternate coverage through the exchange (and possibly qualify for subsidies). Likewise, if your employer plan has an outrageous deductibleÃ¢â‚¬”say, $10,000 a yearÃ¢â‚¬”you can shop on the marketplace and receive financial assistance if your income is low enough. Of course, anyone can shop on the marketplaceÃ¢â‚¬”you just might not receive monetary aid if your workplace policy is deemed affordable.
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WhatÃ¢â‚¬â„¢s the deal with HealthCare.gov? Why so glitchy?
What youÃ¢â‚¬â„¢re really asking: Why canÃ¢â‚¬â„¢t the federal government, with its seemingly infinite resources, build a website that works? Ã¢â‚¬Å“I do think there were some underlying glitches in the system itself,Ã¢â‚¬Â says Mayra Alvarez, M.H.A., associate director of minority health for the Department of Health and Human Services and the former director of public health policy for the Office of Health Reform. Ã¢â‚¬Å“And with such great volume coming into the website, it really did expose a lot of those glitches.Ã¢â‚¬Â
There were also some poor design decisions, like requiring users to verify their identity before browsing the marketplace, thus creating a massive bottleneck. This was compounded by the fact that many users werenÃ¢â‚¬â„¢t able to create an account, period, due to internal communication errors.
Then there were actual enrollment issues: Some people who should have qualified for financial subsidies were told they werenÃ¢â‚¬â„¢t eligible for aid. And the reports that informed insurers of whoÃ¢â‚¬â„¢d enrolled each day were confusing, making it hard to know whoÃ¢â‚¬â„¢d actually signed up.
So, where does the site stand, nearly two months post-launch? Alvarez says two-thirds of the Ã¢â‚¬Å“high-priority bugsÃ¢â‚¬ÂÃ¢â‚¬”those deemed responsible for enrollment issuesÃ¢â‚¬”have been remedied. Response time has dropped from eight seconds to less than one second for most users, and the error rate is now below 1 percent.
Yes, the site was glitchy, and itÃ¢â‚¬â„¢s still not perfect (although the administration expects it to be running smoothly for most users by the end of November). But itÃ¢â‚¬â„¢s worth another try if your plan is being scrappedÃ¢â‚¬”or youÃ¢â‚¬â„¢re unhappy with your workplace coverage.
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If I want to purchase a plan through ObamaCare, can I skip HealthCare.gov altogether?
You can sign up by mailing in an application or calling an 800-numberÃ¢â‚¬”but even the pen-and-paper route isnÃ¢â‚¬â„¢t going as smoothly as planned since mailed-in applications still have to be entered into the bogged-down website.
Same for applications submitted via the 1-800 number: The call-center staff can process your application, but Ã¢â‚¬Å“itÃ¢â‚¬â„¢s all using the same system,Ã¢â‚¬Â says Alvarez. That said, the people manning the phones do have a more Ã¢â‚¬Å“direct lineÃ¢â‚¬Â to HealthCare.gov, she says. Ã¢â‚¬Å“ThereÃ¢â‚¬â„¢s a specific resource center for call-center representatives to get their questions answered.Ã¢â‚¬Â (And you donÃ¢â‚¬â„¢t necessarily have to call to pick a plan. Ã¢â‚¬Å“Sometimes folks just want to talk to someone and ask questions,Ã¢â‚¬Â says Alvarez.)
While call centers are swampedÃ¢â‚¬”theyÃ¢â‚¬â„¢ve already fielded more than 3 million calls, according to the Department of Health and Human ServicesÃ¢â‚¬”Alvarez expects service to improve as the website does. (And note: If you live in a state with its own marketplace, you can bypass HealthCare.gov and sign up through your local exchange, although some stateÃ¢â‚¬â„¢s sites have had issues of their own.)
Hate the idea of sitting on hold? You can find face-to-face help, too. Ã¢â‚¬Å“There are people called navigators and assistersÃ¢â‚¬”they can be at health departments, community organizations, or charitable organizations,Ã¢â‚¬Â says Wood. (The difference is just in funding: Navigators are trained by the states since legislation initially banned the use of federal grants for this purpose. Later, the Obama administration decided to allocate funds for in-person help, thus the installment of 18,000-plus assisters.)
To find aid in your area, visit HealthCare.gov, click on the Ã¢â‚¬Å“Find Help ApplyingÃ¢â‚¬Â icon, then plug in your zip code. Fear not: Ã¢â‚¬Å“You donÃ¢â‚¬â„¢t have to get into the guts of the website,Ã¢â‚¬Â says Wood, so glitches shouldnÃ¢â‚¬â„¢t be an issue.
The other option: Seek assistance from insurance brokers and agents. Ã¢â‚¬Å“They certainly have a lot of expertise,Ã¢â‚¬Â says Wood, Ã¢â‚¬Å“but there is a conflict of interest there.Ã¢â‚¬Â Read: While navigators and assisters arenÃ¢â‚¬â„¢t financially motivated to help you pick a plan, insurance brokers are. That said, even if theyÃ¢â‚¬â„¢re pushing you toward their plans, theyÃ¢â‚¬â„¢re still required to let you know about your options in the marketplace, too.
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But I donÃ¢â‚¬â„¢t want health insurance. Are there any options for me?
Well, you could just pay the fine: If you havenÃ¢â‚¬â„¢t signed up for coverage by March 31 of next year, youÃ¢â‚¬â„¢ll be hit with a tax of $95 or 1 percent of your income, whichever is greater. That may sound like a decent deal nowÃ¢â‚¬”heck, thatÃ¢â‚¬â„¢s cheaper than most monthly premiums!Ã¢â‚¬”but the fine will keep inching up each year, until 2016, when it reaches $695 or 2.5 percent of your income (again, whichever is greater). ThatÃ¢â‚¬â„¢s a hefty chunk of change.
Convinced you need to cave, but donÃ¢â‚¬â„¢t want to fork over much cash?
If youÃ¢â‚¬â„¢re part of the under-30 crowdÃ¢â‚¬”the group called Ã¢â‚¬Å“the young invinciblesÃ¢â‚¬ÂÃ¢â‚¬”you have a couple options: You can jump on your parentsÃ¢â‚¬â„¢ plan (if youÃ¢â‚¬â„¢re under age 26), thanks to the Affordable Care ActÃ¢â‚¬â„¢s expansion of dependent coverage, says Salganicoff.
If you want to go solo, there are Ã¢â‚¬Å“catastrophic plansÃ¢â‚¬ÂÃ¢â‚¬”scary name, right?Ã¢â‚¬”available to under-30 consumers or those with hardship exemptions (see the list here), which have low monthly premiums and very high deductibles should you need medical attention. Ã¢â‚¬Å“If youÃ¢â‚¬â„¢re somebody who doesnÃ¢â‚¬â„¢t use any health care, that might be an affordable option for you,Ã¢â‚¬Â says Salganicoff. Ã¢â‚¬Å“They cover all the preventive services.Ã¢â‚¬Â However, these plans donÃ¢â‚¬â„¢t cover any of the essential benefits (for more info on these, see Ã¢â‚¬Å“Why does everyone have to be covered for maternity care?Ã¢â‚¬Â)Ã¢â‚¬”apart from three primary care visits each yearÃ¢â‚¬”before youÃ¢â‚¬â„¢ve met your deductible. TheyÃ¢â‚¬â„¢re also not eligible for financial subsidies.
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IÃ¢â‚¬â„¢m entering the exchange. What do I need to know?
The plans are organized into five tiers: catastrophic, bronze, silver, gold, and platinum. Beyond the catastrophic plans (see Ã¢â‚¬Å“But I donÃ¢â‚¬â„¢t want health insurance. Are there any options for me?Ã¢â‚¬Â), Ã¢â‚¬Å“Bronze level plans have the lowest [monthly] premiums, but higher co-pays and deductibles and more restricted coverage,Ã¢â‚¬Â says Wood. Translation: YouÃ¢â‚¬â„¢ll pay less up front, but if you get sick, your out-of-pocket costs could be higher than if youÃ¢â‚¬â„¢d chosen an upper-tier plan. Ã¢â‚¬Å“If youÃ¢â‚¬â„¢re in the Platinum plan, you would have much lower co-pays and deductibles and much broader coverage,Ã¢â‚¬Â she says.
Broader coverage doesnÃ¢â‚¬â„¢t mean different benefits, though. Every plan on the exchange includes the Ã¢â‚¬Å“essential benefitsÃ¢â‚¬Â (see Ã¢â‚¬Å“Why does everyone have to be covered for maternity care?Ã¢â‚¬Â); the difference comes down to the percentage of the bill that your provider covers. Bronze plans foot the bill for 60 percent of the expected cost of care; Silver plans take care of 70 percent, Gold 80 percent, and Platinum 90 percent. (You may see this referred to as the Ã¢â‚¬Å“actuarial valueÃ¢â‚¬Â of the plan.)
This may sound complicated, but comparing plans is actually designed to be easier than it has been in the past. Ã¢â‚¬Å“The plans have to put out in plain language the description of benefits and are supposed to all be in a similar format,Ã¢â‚¬Â says Wood. Ã¢â‚¬Å“ItÃ¢â‚¬â„¢s not going to be highly technical or detailed.Ã¢â‚¬Â
What about price? Good news: You may not have to cling to your wallet as tightly as you thought. Ã¢â‚¬Å“Overall, the premiums have been at or below what people thought the insurance companies would price their plans at,Ã¢â‚¬Â says Wood. Ã¢â‚¬Å“So that was actually a big win.Ã¢â‚¬Â Adds Alvarez: Ã¢â‚¬Å“Many of our estimates show that six out of 10 Americans are going to pay less than $100 [a month] for coverage. ThatÃ¢â‚¬â„¢s less than the cost of a cell-phone bill.Ã¢â‚¬Â Even better, many young people are looking at premiums of less than $50 per month [at the Bronze level], she says.
Overall, the average monthly payment, without subsidies, for a Silver Benchmark PlanÃ¢â‚¬”i.e. the second-cheapest Silver planÃ¢â‚¬”is $328, according to a government report based on data in 48 states. Out-of-pocket costs, of course, vary, but the new law does guarantee that youÃ¢â‚¬”a single personÃ¢â‚¬”wonÃ¢â‚¬â„¢t pay more than $6,350 in co-pays or deductibles next year.
Once youÃ¢â‚¬â„¢ve found an affordable plan, seeing if your preferred doctors will be in your new network is the next step. Ã¢â‚¬Å“That sometimes has been difficult to determine,Ã¢â‚¬Â admits Salganicoff. Her advice: Just pick up the phone, and call your potential insurance provider. You can ask for your docs by name.
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Am I eligible for subsidies?
It depends on your incomeÃ¢â‚¬”which, by the way, can be well above the poverty line and still qualify. Ã¢â‚¬Å“If young people donÃ¢â‚¬â„¢t get insurance through their jobsÃ¢â‚¬”but have incomes higher than the Medicaid eligible incomeÃ¢â‚¬”they may well receive subsidies because itÃ¢â‚¬â„¢s their first or second job,Ã¢â‚¬Â says Wood. If youÃ¢â‚¬â„¢re single, for example, and earn $44,259Ã¢â‚¬”the average starting salary for 2012 college grads, according to the National Association of Colleges and EmployersÃ¢â‚¬”you could qualify for reduced monthly premiums in the form of advance tax credits, which means youÃ¢â‚¬â„¢d see the discount immediately.
Anyone whose income is at poverty level or up to four times that amount may qualify for these tax credits. Ã¢â‚¬Å“The tax credit will be automatically deducted from the costs that people see [on HealthCare.gov],Ã¢â‚¬Â says Alvarez. Ã¢â‚¬Å“Therefore, theyÃ¢â‚¬â„¢ll know clearly what theyÃ¢â‚¬â„¢re going to be paying.Ã¢â‚¬Â
If your income is at poverty level or up to 2.5 times that, you could also be eligible for cost-sharing subsidies, tooÃ¢â‚¬”that is, help with out-of-pocket costs, like co-pays and deductibles.
The bummer: If your state isnÃ¢â‚¬â„¢t expanding Medicaid coverage and you earn less than the federal poverty level (about $11,500 a year for a single person), you may not be eligible for marketplace subsidies at all. ThatÃ¢â‚¬â„¢s rightÃ¢â‚¬”if you donÃ¢â‚¬â„¢t already qualify for Medicaid and you live in a state that opted not to expand the program, you may fall in the unfortunate no manÃ¢â‚¬â„¢s land, Ã¢â‚¬Å“the coverage gap,Ã¢â‚¬Â where you donÃ¢â‚¬â„¢t qualify for any kind of help.
Want to see where you stand? Plug your infoÃ¢â‚¬”state, annual income, family size, etc.Ã¢â‚¬”into the Kaiser Family FoundationÃ¢â‚¬â„¢s Subsidy Calculator to find out.
And for more info on the coverage gap, visit Healthcare.govÃ¢â‚¬â„¢s explanation of it.
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What happens if not enough young people sign up?
The whole system implodes. OK, not reallyÃ¢â‚¬”but prices could shoot up if the 2.7 million 18- to 35-year-olds President Obama is counting on donÃ¢â‚¬â„¢t enroll. (That comes out to 38 percent of the total number of anticipated customers.) Ã¢â‚¬Å“If only the sick sign up, then there wonÃ¢â‚¬â„¢t be enough premiums in the pool to pay for the cost of care,Ã¢â‚¬Â says Wood. Ã¢â‚¬Å“Therefore, premiums would have to go up.Ã¢â‚¬Â
So far, about 20 percent of enrollees are 18 to 34 years old, based on early data from Connecticut, Kentucky, Washington, and Maryland. This is no surprise, though, since the sickest people are likely to be the most eager to get covered. (And letÃ¢â‚¬â„¢s face it: Young people tend to procrastinate. Many may be waiting until closer to the deadline to sign up.)
Wood anticipates that the perks specifically benefiting young peopleÃ¢â‚¬”free birth control, for oneÃ¢â‚¬”will lure them to the marketplace. Ã¢â‚¬Å“If you donÃ¢â‚¬â„¢t have to pay your co-pay for contraception, that can be $10, $20, $40 a month in your pocket,Ã¢â‚¬Â she says. Ã¢â‚¬Å“So thatÃ¢â‚¬â„¢s reason to have the insurance.Ã¢â‚¬Â
Admits Alvarez, Ã¢â‚¬Å“IÃ¢â‚¬â„¢ll be the first to tell you, itÃ¢â‚¬â„¢s not going to be us, the government alone, thatÃ¢â‚¬â„¢s going to [attract young people].Ã¢â‚¬Â She cites her 20-year-old sister as an example, who she says probably has no clue what HealthCare.gov is. Ã¢â‚¬Å“But she will listen to Pandora commercials or what Instagram posts are going out or what Facebook says,Ã¢â‚¬Â says Alvarez. Ã¢â‚¬Å“ThatÃ¢â‚¬â„¢s why the department is really trying to use social media as a medium of communication with young people and is also partnering with organizations that have that reach, like the Young Invincibles and Planned Parenthood.Ã¢â‚¬Â
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Speaking of contraception: IÃ¢â‚¬â„¢ve heard that some employers are refusing to offer it. WhatÃ¢â‚¬â„¢s the deal?
Nobody can argue with colonoscopies or cholesterol tests. But contraception has long been a hotly debated topicÃ¢â‚¬”even before the Affordable Care ActÃ¢â‚¬”so itÃ¢â‚¬â„¢s no surprise that some employers are rebelling against the Ã¢â‚¬Å“Contraception for all!Ã¢â‚¬Â ruling. Ã¢â‚¬Å“They started straight out of the gate with an exception for churches,Ã¢â‚¬Â says Wood. Ã¢â‚¬Å“If youÃ¢â‚¬â„¢re a house of worship, youÃ¢â‚¬â„¢re off the hook.Ã¢â‚¬Â But then religiously affiliated organizationsÃ¢â‚¬”schools, universities, charities, hospitalsÃ¢â‚¬”began bucking the birth-control mandate, too. The ruling: These employersÃ¢â‚¬”the ones that arenÃ¢â‚¬â„¢t churches but do have a religious foundationÃ¢â‚¬”donÃ¢â‚¬â„¢t have to foot the bill for contraceptive coverage, but the insurance company will still cover it.
Now, for-profit corporations like Hobby Lobby are starting to protest the Pill because of the religious beliefs of their owners. Ã¢â‚¬Å“Courts around the country are split,Ã¢â‚¬Â says Wood. Ã¢â‚¬Å“This is probably going to go to the Supreme Court to decide.Ã¢â‚¬Â But, remember, this only is an issue among employers. Plans sold on the exchange are individual plans, and they will all cover contraception, she says.
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Why does everyone have to be covered for maternity care?
The Affordable Care Act requires insurers to cover 10 essential benefits with no lifetime or annual limits:
1) Outpatient care
2) Emergency care
3) Hospital stays
4) Mental health services
5) Prescription drugs
6) Rehab services
7) Lab services
8) Free preventive care
9) Maternity and newborn care
10) Pediatric care (including vision and dental services)
Not all of us will use all of these services: You may never need therapy, for example, or never have an accident worthy of the E.R. (ItÃ¢â‚¬â„¢s nice to know you could afford them if you needed them, thoughÃ¢â‚¬”right?) But under the Affordable Care Act, insurers can no longer discriminate by gender (women have historically paid more than men, even without maternity coverage) or preexisting conditionsÃ¢â‚¬”only by age or smoking status. That means all plans have to essentially look the same.
Ã¢â‚¬Å“If it were personalized, [insurers] would be looking at you, saying, Ã¢â‚¬ËœYouÃ¢â‚¬â„¢re a certain age, you have a family history of heart disease and cancer, you had high blood pressure five years ago. So we should charge you more,Ã¢â‚¬â„¢Ã¢â‚¬Â says Wood. Ã¢â‚¬Å“But thatÃ¢â‚¬â„¢s not how weÃ¢â‚¬â„¢re doing it. Everyone is in, everyone pays a fair rate, and we have enough money in the system to take care of people when they need it.Ã¢â‚¬Â
So why is everyone obsessing over maternity care? Because itÃ¢â‚¬â„¢s gender-specificÃ¢â‚¬”but thereÃ¢â‚¬â„¢s a good reason to include it. Ã¢â‚¬Å“Maternity care has been a huge gap for women in the individual insurance market,Ã¢â‚¬Â says Salganicoff. Ã¢â‚¬Å“It was considered a pre-existing condition.Ã¢â‚¬Â That means women facing unexpected pregnancies would often find themselves uninsuredÃ¢â‚¬”which is why Medicaid was paying for half of all deliveries, says Wood.
Even though this differs from the traditional structure of individual plansÃ¢â‚¬”which are essentially ÃƒÂ la carte policiesÃ¢â‚¬”this Ã¢â‚¬Å“newÃ¢â‚¬Â comprehensive model is actually quite similar to the existing employer-based approach. Says Wood: Ã¢â‚¬Å“Employer-based plans all cover maternity care, even for men, because theyÃ¢â‚¬â„¢re providing all medically necessary services.Ã¢â‚¬Â (Salganicoff adds that the Pregnancy Discrimination Act of 1964 made it illegal for employers to not cover maternity care).
Read: Men with workplace plans are already paying for the pregnancies theyÃ¢â‚¬â„¢ll never have.
Ã¢â‚¬Å“This is the model of health insuranceÃ¢â‚¬”that you need to have a pool of individuals, a collective risk,Ã¢â‚¬Â says Salgnicoff.
Again, that means not every person benefits from every benefit. And although the list specifically mentions maternity care, there are male-specific services covered, too, like care for prostate or testicular troubles and an abdominal aortic aneurysm screening for men whoÃ¢â‚¬â„¢ve never smoked. Ã¢â‚¬Å“Men and women are biologically different,Ã¢â‚¬Â says Salganicoff. Ã¢â‚¬Å“Covering one service for women doesnÃ¢â‚¬â„¢t mean you are discriminating against men.Ã¢â‚¬Â
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More from WomenÃ¢â‚¬â„¢s Health:
Not Having Health Insurance Kills Thousands Each Year
8 Things You Need to Know About the Insurance Marketplace
A Message From the HHS Dept. Secretary