Women in employer-sponsored health plans are getting less coverage than men for every premium dollar spent, and face an additional $15.4 billion annually in out-of-pocket healthcare expenses, according to new research by accounting firm Deloitte.
In an analysis of 16 million people covered by employer-sponsored health plans, including a mix of large and small employers, Deloitte found that women’s average out-of-pocket costs are higher than men’s at every age from 19 through 64 — even excluding pregnancy-related services.
The gender wage gap likely contributes to some of the disparities found in the study, said Dr. Kulleni Gebreyes, Deloitte’s chief health equity officer and life sciences and healthcare sector leader. Last year, women earned 82 cents for every dollar earned by men, according to the Pew Research Center. “We know that health and wealth are linked,” Gebreyes said, and people who can’t afford regular doctor visits may have more high-cost trips to the emergency room.
Plan benefit design — such as the copay for each service — can result in health plans delivering more value for men than for women, Deloitte found. The relatively high cost of breast-cancer imaging compared to other cancer types and the effects of menopausal transitions may play a role, according to Deloitte. Key spending categories for women include radiology — such as follow-ups after an abnormal mammogram — as well as labs and mental health, the study found.
Six out of 10 U.S. women age 19 through 64 are covered under employer-sponsored health plans, according to health-policy nonprofit KFF.
Under the Affordable Care Act, insurance companies can’t charge women and men different premiums for the same plan, and most private health plans must cover an array of preventive services, including screenings for breast and cervical cancers, wellness visits and prescribed contraceptives. “Our healthcare system has done a great job driving equity for access,” Andy Davis, principal in the healthcare practice at Deloitte, said in a statement. “Equity in benefits is the next challenge to address because benefits should be designed to support every person.”
While women generally use more healthcare services than men, that doesn’t fully explain the gender gap, according to Deloitte. Total health expenditures for women are 10% higher than for men, but women’s average annual out-of-pocket spending is 18% higher than men’s, the study found. For all 2021 claims reviewed, women’s out-of-pocket spending was 20% higher than men’s, and removing maternity claims only closed the gap by less than 2%, according to the study.
Deloitte also analyzed the average percentage of total health claims covered by insurance for women versus men, and found that women consistently get less value for every premium dollar spent — regardless of whether maternity claims were included in the analysis.
Maternity services, Gebreyes noted, are one area where women tend to get more bang for the buck. Women who give birth in a given year generally exceed their out-of-pocket maximum, “so they tend to have better value for the dollar,” she said.
To help level the playing field, employers can focus on designing benefits to equalize the actuarial value — or percentage of total average costs covered by the plan — for men and women, Gebreyes said. While many employers focus on premium costs, she said, the gender gap in actuarial value is “lurking under the surface.”
Given the effects of health-insurance plans’ design, combined with the wage gap and the “pink tax” — or higher prices on products marketed to women — many women are “having to make really hard choices on how they spend every dollar they have,” Gebreyes said.
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