WASHINGTON — A 25-year-old woman seeking health insurance in North Carolina on her own could expect to pay $60 to $300 a month for her coverage.
Her twin brother? Up to 50 percent less.
North Carolina is one of nearly 40 states that still allow health insurance companies to consistently charge women more than men for the same coverage.
The practice, known as gender differentiation, could be banned under nearly all of the health overhaul bills now being considered in Congress.
A News & Observer/Charlotte Observer review of health-care premiums in North Carolina found that until patients reach their 50s, women are consistently charged more than men.
For example, a Blue Cross and Blue Shield comprehensive policy with a $2,500 deductible would cost a 38-year-old Durham man $182 a month. For a woman of the same age and hometown, the cost jumps to $269 -- a difference that amounts to an extra thousand dollars a year. Add optional maternity coverage, and the monthly premium would leap to $490 a month.
Prices were similar at other insurance companies, including Aetna, UnitedHealthOne, CoventryOne and Celtic.
Insurance companies say the differential makes sense because women routinely cost more to care for than men, especially at child-bearing age.
"It used to be that insurance companies charged by race, and that fell away as a reason to charge differential premiums, and we think it is time that gender rating disappeared as well," said Judy Waxman, vice president of health and reproductive rights at the National Women's Law Center in Washington.
Michelle Titsworth of Greensboro shopped around this year for health insurance but found nothing she could afford.
Getting health insurance through her part-time job as a library assistant would have cost $200 a month. Adding herself onto her husband's health plan -- which already covers the couple's three young children -- would cost even more, she said.
"With bills and everything, we would be in the negative," said Titsworth, 26, whose husband works two jobs. "We're barely making it right now."
Titsworth was frustrated enough to write U.S. Sen. Kay Hagan last spring to complain about how the health system seems to affect women.
"I can't afford it for myself," Titsworth said. "Me as a woman -- that I can still have babies -- it's a lot pricier."
This month, Hagan joined several female senators in pushing for a health bill that they say would treat women more fairly. Last week, she spoke on the Senate floor of how her grown daughter would be charged more because of her gender.
"I think the equal premiums for equal coverage is what we're looking for under health-care reform," she said.
How insurers think
Other issues affect women as well.
Among the pre-existing conditions that can be used to deny coverage to women on the individual health insurance market are pregnancy and previous cesarean sections.
"You have to think the way insurance companies think," Waxman said. "If you've had a C-section once and want to have another child, you may have a C-section twice. They think, 'You've had a C-section. We're upping your premiums, or we're not covering you for maternity. It costs too much.'"
The National Women's Law Center also lists North Carolina among eight states that do not specifically prohibit domestic violence as a pre-existing condition.
The state's Department of Insurance, which regulates health insurance companies, disputes that claim.
State law only allows insurance companies to use actual medical conditions as pre-existing conditions, said Kristin Milam, spokeswoman for the department. That wouldn't include domestic violence, she said. Plus, she added, the office reviews companies' application forms to ensure that the questions are appropriate.
"It's not happening here in North Carolina, and if it did happen, we wouldn't let it happen," Milam said.
Calls to companies that sell individual plans in North Carolina were either not returned or referred to the state or national association that represents health insurance companies. "What we know is that at younger ages, women use more health-care services than men, and that's reflected more in the premiums they pay," said Robert Zirkelbach, spokesman for America's Health Insurance Plans in Washington.
Ted Hamby, a deputy commissioner at the state Department of Insurance, said many services are based on women's gender, including gynecological care, cervical cancer screenings and mammograms.
Both said the trend reverses as patients age, with men eventually charged more.
A News & Observer/Charlotte Observer review found that for many individualized health insurance plans, men begin to cost more than women once they both reach their 50s. A quote from Blue Cross and Blue Shield of North Carolina showed men cost more and are charged more than women at age 61.
Zirkelbach said his group supports ending gender differentials for health plans, as long as the health-care overhaul includes mandated coverage for everyone. Universal coverage would provide companies more business, he acknowledged, but it would help patients as well.
"To make that work, we need everyone to participate," Zirkelbach said. "It's good for everybody if we can get a system where everybody's getting the health care they need at an early stage."
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