KFF: Women Experience Insurance Coverage Problems More Than Men

KFF: Women Experience Insurance Coverage Problems More Than Men


More women had challenges with insurance coverage for health services than men in the last 12 months, a recent Kaiser Family Foundation (KFF) survey found.

About 31% of women ages 18 to 64 with health coverage said that in the last year, they or a family member received care that their health plan did not cover at all or paid less than expected. In comparison, 26% of men said this.

These findings are from the 2022 KFF Women’s Health Survey, which included responses from 5,201 women and 1,241 males. It was conducted from May 10 to June 7.

The survey found that 29% of women said their health plan would not cover a prescription medication (or required an expensive copay or coinsurance for the medication), compared to 21% of men. Additionally, 20% of women said their plan didn’t cover a test or scan recommended by the doctor, versus 17% of men.

“These gender differences could be due to several factors, including that women are more likely than men to have visited a health care provider in the past two years, to take prescription medication on a regular basis, and to have an ongoing health condition that requires regular monitoring, medical care, or medication,” KFF said.

These problems differ depending on the type of insurance women have. About 34% of women with private insurance said their plan did not cover medical care they thought was covered (or covered less than they thought it would), compared to 21% of women with Medicaid.

Other findings from the KFF survey include:

  • Despite the fact that many insurance companies are required to have an appeals process for coverage determinations and claims, many women are unaware of this option. Of the 65% of women who regularly take prescription medication, only 40% knew they could file an appeal.
  • This issue varies by income and insurance type. About 44% of insured low-income women who take prescription medication are aware of this option, compared to 38% of high-income women. Additionally, 45% of women with Medicaid are aware they can file an appeal, versus 38% of women with employer-sponsored insurance.
  • Of the women who take prescription medication, 32% said their out-of-pocket costs have increased in the last year. About 54% said they’ve stayed the same, 6% reported they decreased and 8% said they don’t know.

“Despite the role that health insurance plays in helping people afford health care and reducing patients’ financial risks when they need routine care, get sick, or need to be hospitalized, scope of coverage and affordability can still be challenging for many women with insurance coverage,” KFF said. “A sizeable minority of women with insurance report having problems using their health plan, such as their plan not paying for health care they thought was covered but was not, or their plan not covering their prescription drugs or requiring high cost sharing for them.”

Photo credit: Andrii Shyp, Getty Images



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