Here’s how much women could pay for preventive care under the AHCA
Without essential health benefits, women may have to pay thousands over the years for birth control, cancer screenings, and routine vaccines
Women stand to lose a lot if the new Republican healthcare bill becomes law.
When President Obama passed the Affordable Care Act, better known as Obamacare, in 2010, preventive care became one of the 10 essential health benefits that must be completely covered by insurance. The American Health Care Act (AHCA) would allow states to opt out of that provision, forcing patients to pick up the costs—which could disproportionately affect women.
Many of those essential health benefits, including birth control, cancer screenings, and routine vaccines, are crucial to women’s health. But without insurance coverage, they could be prohibitively expensive. We looked into our database of 9 billion health insurance claims to see how much these medical services could cost out of pocket.
To be clear: these costs have always existed—but the AHCA would allow states to shift the cost burden from insurance companies to the patient. From Amino’s data, we identified a median network rate estimate for 8 procedures that are currently included in Obamacare’s essential health benefits. This network rate is similar to the “allowed amount” that insurance companies currently negotiate with providers. We’re using our network rate in this analysis to estimate what women may have to pay if their insurance no longer covers preventive care.
Here’s what women could face:
About $1,000 for an IUD. Our median network rate estimate for a Mirena IUD is $1,111. Skyla and Paragard IUDs would likely cost about the same, at $983 and $1,045 respectively. Tweet
A whopping $4,000 for tubal ligation, which about 25% of women using contraception choose, particularly when they’ve decided to stop having children. Tweet
About $250 for a standard mammogram to screen for breast cancer, which women over age 45 are supposed to get every one to two years. Tweet
About $1,500 for a standard colonoscopy to check for signs of colon cancer. Tweet
Just over $200 for a Pap smear to screen for cervical cancer—a hefty chunk of change for a standard, recurring medical expense (every few years) that only women get. Tweet
More than $300 for a single HPV vaccine that helps prevent cervical cancer—and patients need 2-3 doses to complete the schedule. Tweet
We also found that costs could range across the US—keep reading to see a state-by-state breakdown. If you’re interested in how we determined these cost estimates, read our methodology below.
Obamacare covers all sorts of contraception, including birth control pills, long-acting reversible birth control like IUDs and the Nexplanon skin implant, and tubal ligation (permanent sterilization)—all of which women might have to pay for out-of-pocket if the AHCA passes.
Since our insurance claims database clearly shows when women are receiving in-office procedures, we decided to look at how much an IUD or tubal ligation could cost without that coverage.
Amino’s median network rate estimate for a Mirena IUD (a popular type of long-acting reversible birth control) is currently $1,111. Without mandated coverage, women may be responsible for paying the full cost. In Alaska—the most expensive state for 7 out of the following 8 preventive care services—it could be even costlier ($1,586).
For women considering an IUD, other brands may not be any cheaper. A Skyla IUD could also cost around $1,000.
Similarly, a Paragard IUD could cost $1,045.
And women considering a more permanent form of birth control—tubal ligation—could face a shockingly pricey $4,000 bill. It could be as much as $6,876 in the most expensive state for the procedure, Wyoming.
Obamacare also covers cancer screenings, which includes routine mammograms, colonoscopies, and Pap smears. These, too, could be remarkably expensive for women if coverage isn’t mandated.
A routine screening mammogram—which women over the age of 45 are supposed to get every few years to check for breast cancer—could cost patients more than $250 each time. In Alaska, it could cost nearly twice that ($490).
A colonoscopy—which both women and men over the age of 50 are supposed to get every 10 years to check for colon cancer—may cost patients more than $1,500.
And a Pap smear, which women ages 21-65 get every few years to screen for cervical cancer, could cost more than $200. The least expensive state for a Pap smear, Alabama, still has a median network rate estimate of $160.
Obamacare made about 10 different vaccines free for all adults (covered completely by insurance). All are essential, but one is particularly important for women: the HPV vaccine. It protects against certain cancers that can develop from HPV infection—particularly cervical cancer—and it’s recommended for all young women through age 26.
Our current median network rate estimate for a single dose of the HPV vaccine is $319—and women need two to three doses to fulfill the vaccination schedule (so costs could be around $630 to $960 total). All of this cost could be passed on to the patient under the AHCA. In Alaska, a single dose could cost over $500.
The cost of preventive care adds up over time
The AHCA has to pass the Senate before it becomes law—and a lot could change in that process. But if the essential health benefits waiver stays, these costs could become seriously burdensome for women seeking basic care.
According to a nationwide survey we conducted with Ipsos in March 2017, 37% of Americans said they could not afford an unexpected medical bill greater than $100 without going into debt. And women are more affected than men here—44% of women would go into debt if they received a bill greater than $100.
If preventive services suddenly carry a price tag of hundreds (or thousands) of dollars, women may find themselves in serious financial trouble. Others may avoid going to the doctor altogether.
Consider a young woman between the ages of 30 and 35. Let’s say she decides to get a Mirena IUD at age 31 (the median age that women get one) at a cost of $1,111. She also gets a Pap smear every two years—so twice during that time frame—at $206 each. She could pay $1,523 total out of pocket for these standard women’s health services alone over the course of five years—and that’s not including emergency costs, annual physicals, or premiums for her health insurance plan that no longer covers preventive care.
An older woman between the ages of 60 and 65 could pay even more, since cancer screenings are frequent and pricey. She, too, would need two Pap smears at $206 each. If she also gets three mammograms (one every two years) at $267 each and one colonoscopy at $1,628, she could pay $2,841 total just for basic care over the course of those five years. (Plus, we’re assuming there’s no inflation and medical costs don’t increase in that time.)
Keep in mind that no one knows for sure what will happen at this point. Perhaps insurance companies will step in and keep essential health benefits covered, the Senate will remove the waiver provision, or certain states will enact their own laws that protect patients. But as it currently stands, the bill could have a huge impact on women’s wallets.
Use Amino to estimate your current cost
You can use Amino to see a current cost estimate for any of the preventive care services discussed above. After entering your information below, select a doctor and click “calculate what you’ll pay” to see an out-of-pocket estimate customized to your insurance.
Amino's database has billions of health insurance claims from 129 insurance companies, which means we're able to show cost estimates for common medical procedures, doctors, insurance companies, and geographic regions.
We call our cost estimate the "network rate"—this is how much you and your insurance company together would pay a doctor or hospital for a procedure. You can learn all about how we determine our network rate estimates here. For this article, we looked at the median network rate estimates for each state and the country as a whole.
If the AHCA is signed into law and states waive essential health benefits, we hypothesize that the total cost Amino currently shows (the network rate estimate) could be passed down to you. However, your actual out-of-pocket costs for any of these procedures could be influenced by many factors, including whether your state decides to waive essential health benefits or, if not, what (and how much) your insurance chooses to cover, as well as your insurance plan design (deductible, copays, coinsurance, and out-of-pocket max) if they do choose to keep it partially covered.
Data analysis and visualizations for this blog post by Sohan Murthy