Sunday, February 2, 2014

Birth Control and Health Insurance - Why it Won't Pay

Why do insurance policies pay for men to buy Viagra but won't pay for birth control for women?

This is a very common question that touches on what seems to be  sexual discrimination on the part of health insurance companies.

It helps to understand that not all policies follow the same rules. Mostly, it's a matter of the kind of coverage you have.

Group health insurance plans, the kind a business buys as a benefit for employees, are likely to pay for the birth control. Individual plans, that people buy directly from the insurance company, are not.

Group plans will cover maternity, so preventing pregnancy is helpful in keeping costs down.

Individual plans only offer maternity coverage if you choose the maternity rider and pay extra. If you don't pay the extra premium, the delivery costs won't be paid by the insurance company anyway, so they don't save money by paying for birth control.

In addition, individual plans are medically underwritten, meaning that not all applicants are accepted and the pricing for those who are accepted varies from one person to the next.

Rates for underwritten policies are affected by an applicant's status regarding factors such as age, weight and whether the applicant takes medication. The insurance company charges more for people who take medications because the costs of paying for that person's medical expenses will obviously be higher than for someone who does not take medication.

So, even if the individual plan did cover birth control pills, the policyholder would probably end up paying more than the birth control pills are worth.

It is also true that insurance companies commonly will only pay for services that are "medically necessary". While some may argue about whether Viagra or Cialis are medically necessary, erectile dysfunction is, by definition, a condition where a normal biological function is not working properly. Ovulation, on the other hand, is totally natural. Not a dysfunction at all.

So, while gender discrimination is still all too common in the world, it is not the real the reason for this  apparent unfairness in health insurance.

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