My mom was just 48 when she was diagnosed with breast cancer. Because of her age, her doctors suspected a genetic component and urged her to undergo genetic testing.
This was 20 years ago, well before the Affordable Care Act mandated that those tests be covered. My mom wanted to pay for it so we might have a clue about my own risk level, but I didn’t want her to spend $10,000 or more.
I was in my late 20s then. If her tests came back positive, I would need to be tested, too. At an additional $5,000, that felt financially out of reach, so we decided to forgo genetic testing.
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Still, her diagnosis forced me to think differently about my health, and I tried to work proactively with my doctors. Rather than standard mammograms, my doctors recommended annual MRIs, since mammograms are not as effective for young women with dense breast tissue.
But insurance didn’t see it that way. They labeled the screenings “medically unnecessary” and flat-out refused to cover them, even with a direct family history of cancer.
The pink tax is alive and well
Across the board, women like my mom and me pay more for health care. According to the World Economic Forum, the average American woman spends 18% more on health expenses than a man. It’s part of a broader pattern you may know as the “pink tax.”
We’ve all seen it: higher prices on shampoo, razors, dry cleaning and clothing. In health care, the pink tax shows up in our medical bills.
Excluding pregnancy (don’t get me started on that), women pay an average of $266 more per year than men. That may not sound like a lot, but it adds up.
Over time, nearly every major health expense we face is tied to gender: contraception, fertility treatments, pregnancy and childbirth, menopause, osteoporosis, dementia, autoimmune conditions, cancers of the breast, ovaries, cervix and uterus, and the list goes on and on.
And, when we’re not paying for our own care, we’re often the ones providing it.
Women are far more likely to become unpaid caregivers for aging parents, ill spouses or children with medical needs. That caregiving comes at a steep cost: lost wages, foregone promotions and reduced retirement savings.
It’s an invisible tax that slowly eats away at our long-term financial security.
Where the gap hurts most
The health care system’s biggest blind spots often align with uniquely female health concerns. Take reproductive care.
The cost of contraceptives still falls mostly on women. While the ACA improved coverage, regulatory changes around abortion, contraceptives and fertility treatments are creating new financial hurdles.
When I was considering fertility treatments to conceive my daughter, the cost wasn’t covered in Nebraska, where I lived at the time. Each cycle of in vitro fertilization costs about $12,000, and most couples need several rounds before they conceive.
Today, IVF is covered only by health insurance in a small handful of states.
Then there’s menopause. Every woman goes through it, but comprehensive menopause care remains largely absent from standard insurance coverage. Only 26% of plans cover menopause-related prescriptions in full, according to GoodRx.
Hormone replacement therapy is often treated as optional, even though it’s seen as the gold standard for treating severe symptoms. Without coverage, women must choose between suffering or shouldering the cost themselves.
And it doesn’t stop there. Because of their genetic structure, women are more likely to be diagnosed with autoimmune diseases like lupus, colitis and multiple sclerosis. They’re more likely to take medical leave for a disability during their working years.
And they suffer from Alzheimer’s at twice the rate of men. The Alzheimer’s Association estimates the lifetime cost of care for someone living with dementia to be $405,262. That information is staggering.
Take control of your health care
These health care disparities aren’t going away anytime soon. It’s up to each of us to find ways to protect our physical and financial well-being. Here are a few places to start.
Use your workplace benefits
If you’re employed, start with your health insurance policy. During open enrollment, review your options — especially if you expect higher medical expenses in the coming year. Choose the most comprehensive plan you can afford, even if the monthly premium is higher. It may save you far more in out-of-pocket costs down the road.
Next, explore additional benefits your employer might offer, such as:
- Voluntary supplemental health plans for critical illness or hospital stays
- Mental health services to connect with a therapist
- Caregiving support or employee assistance programs
- Menopause-specific resources (increasingly offered by large employers)
Don’t be shy about asking HR what’s available. These programs are there for you. Use them.
Maximize HSAs and FSAs
Health savings accounts (HSAs) and flexible spending accounts (FSAs) can help offset costs. HSAs, for example, offer a triple tax advantage: Contributions go in tax-free, grow tax-free and can be withdrawn tax-free for qualified medical expenses.
You must pair an HSA with a high-deductible health insurance plan, but you can roll funds over indefinitely, even into retirement.
FSAs, meanwhile, must be used in the year you contribute to them (although you may be able to carry over a small balance year-to-year depending on your employer’s plan).
If you expect high medical bills, say, for fertility treatments, max out your FSA so you can pay for treatment with pre-tax dollars.
Protect your income
Don’t overlook disability insurance. If your employer offers group coverage, consider using it. Short-term disability usually starts within a few weeks and lasts a few months. Long-term coverage typically kicks in after 90 days and can replace around 60% of your salary for up to a few years.
If possible, consider an individual policy to supplement what your employer provides. It’s not cheap, but it can be a lifesaver when you need it most.
Get professional help
A financial adviser can be a great resource for helping you budget for high-cost years and help you analyze your insurance plan. Don’t have an adviser? Start by searching for a CERTIFIED FINANCIAL PLANNER® (CFP®) professional through the CFP Board’s professional directory, which allows you to filter by location, specialization and fee structure.
If you can’t afford an adviser, you can find a pro bono adviser through the Foundation for Financial Planning, which can pair you with a volunteer financial planner for free if you qualify based on income and other circumstances.
Hard-won progress, but still fighting
A year ago, my mom’s cancer returned. She’s fighting it with everything she has. Now that my family history has become impossible to ignore and changes by the ACA have taken effect, genetic testing is covered for her, but still not for me.
However, my insurance company finally treats my case as high risk. For the first time in 18 years, insurance approved an MRI.
The irony isn’t lost on me: Eighteen years of paying out of pocket for the screening that would actually benefit my health, while insurance covered the less effective option.
The pink tax on health care is real. But with dogged planning and advocacy, we can minimize its sting on our financial and physical well-being. Persistence and advocacy can eventually lead to better coverage.
The key is never to accept “no” when it comes to our health.
We shouldn’t have to fight this hard for care that fits our bodies. But until we don’t have to, we need to plan and speak up.
Our lives depend on it.
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