Results from an assessment of young adult-targeted health plans in Massachusetts
The reason is simple: Young adults aged 18-26 are a population that faces one of the highest rates of unintended pregnancy. They have also, historically, been disproportionately uninsured – and thus were purposefully targeted as part of health care reform here in the Commonwealth. So we are collaborating with a broad coalition of Massachusetts health service providers, advocates, and researchers on this unique, statewide project to promote sexual health and ensure that young adults have the resources they need to prevent unplanned pregnancy. Over the first year of the REaDY Initiative, Ibis Reproductive Health is conducting research to see what helps – and hinders – young adults when it comes to using family planning effectively. The first phase – looking at the coverage available for contraception in health plans targeted at younger adults – is now complete! Keep reading for more information. Background In Massachusetts, there are two types of plans that have been specifically designed to provide young adults with affordable health insurance: the Young Adult Plans (YAPs) and the Student Health Program (SHP). However, in an effort to limit the cost of these plans, both the YAPs and the SHPs have been exempted from providing some of the services included in the Minimum Creditable Coverage (MCC) standards required of qualifying health plans in the Commonwealth. These exemptions raise concerns about the degree to which young adults’ contraceptive and other sexual and reproductive health needs are being met. And the plans may be leaving students and young adults in the dark about the limitations of their coverage and their options for obtaining this essential care. Key findings The main aim of the first phase of research is to identify the scope of coverage of contraceptive services and counseling – and the information plans make available about it. This involved first conducting a systematic review of the health plans targeting young adults in Massachusetts. The results of this study raise concerns that young adult-targeted health plans – both the YAPs and the SHPs – may not provide a full range of contraceptive services. First, fully half of the YAPs do not offer a prescription drug benefit, in the interests of controlling costs and providing lower-costs plans. But this also means that they fail to provide coverage for prescription contraceptives – which are the most effective methods of birth control on the market today. This lack of coverage has important implications for young adults’ access to contraceptive services and raises concerns about gender (in)equity in health care financing. Second, our results suggest that students enrolled at some religiously affiliated colleges may faces barriers to obtaining contraceptive services because their plans are allowed to opt out of providing this care – even when they do provide prescription benefits. Finally, publicly available information about the YAPs’ coverage of contraceptive and other sexual and reproductive health services is limited; information that is available is often not highlighted and difficult to find. In contrast, the SHP plans provided more robust information about their coverage – even with the limitations on the benefits provided. The criteria for enrolling in different types of health plans make it difficult for a young adult who is eligible for a plan that excludes contraceptive services to gain access to an affordable alternative that offers this care. For instance, students eligible to enroll in a SHP are barred from enrolling in Commonwealth Care, the subsidized plans for those earning less than 300% of poverty. Similarly, young adults who are offered an employer health benefit are ineligible for enrollment in the YAPs. Recommendations Create information resources to help young adults understand and navigate coverage in the YAPs. Since existing descriptions of young adult-targeted health plans are often difficult to navigate and contraceptive coverage is often unstated or unclear, the YAPs should provide more transparent, accessible, and youth-friendly information.
Address the “gaps” in the YAPs by ensuring contraceptive coverage. Possibilities include 1) requiring that all YAPs meet the prescription drug benefit component of the MCC standards; 2) revising the MCC standards such that young adult-targeted plans must include coverage of a “young adult formulary” (which would include prescription contraceptives); or 3) extending subsidized coverage of family planning services through the Massachusetts Department of Public Health Family Planning Program (MDPH-FPP) to underinsured young adults.
Develop mechanisms for providing contraceptive services to underinsured young adults. As this research shows, a young adult woman might satisfy the individual insurance mandate but still be underinsured with respect to contraceptive care (because she enrolled in a YAP with no prescription drug benefit, a SHP plan that does not provide contraceptive services, or a religiously affiliated health plan through an employer). To ensure she has affordable birth control options, policymakers should consider extending eligibility for MDPH-FPP subsidized services and easing eligibility requirements for Commonwealth Care plans.
Require health plans to disclose limitations and exclusions, including restrictions on contraceptive coverage. As of June 1, 2009, the SHP plans are required to provide information regarding benefits and covered services, including all limitations and exclusions. This effort serves as a model for ensuring transparent communication about the services, including contraceptive counseling and care, that are (and are not) covered. It is imperative that all young adults, not just students, be made aware of any contraceptive exclusions in qualified health plans. All plans, including those that are religiously affiliated, should be required to disclose limitations, exclusions, and departures from the MCC standards. Complete, accurate, and accessible information should be provided to potential and current enrollees. The Health Connector’s website should also provide information about any exclusions pertaining to the Commonwealth Care and Commonwealth Choice plans (including the YAPs) as well as information about affordable alternatives.
Collect more robust data on young adults and health care reform. The Health Connector should collect more data on young adults in the context of health care reform, including their enrollment patterns, health services utilization, and uninsurance rates, as well as demographic information about those enrolled in a YAP or other young adult-targeted plan.
Learn from the experiences and perspectives of clinicians and young adults. Over the next few months, the REaDY Initiative will be conducting research with clinicians who provide care to young adults as well as with young adults enrolled in different plan types. We expect to have preliminary findings from both studies later in 2009.
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