It's not "use it or lose it" when it comes to women and their health insurance; it's "use it or don't use it and still pay more than a man."

The gender gap between what women pay for health insurance and what men pay was a major issue that the Patient Protection and Affordable Care Act intended to address. And while major sections of the law do just that, a new Mercer study reveals that there's much work to be done if the gender gap in insurance premiums is to be truly eliminated.

That gap can be a monster, because it varies state by state. In 2012, the National Women's Law Center took at look at the gap as the PPACA was about to kick in. Among its findings:

  • Gender rating, the practice of charging women different premiums than men, results in significantly higher rates charged to women throughout the country. In states that have not banned the practice, the vast majority, 92 percent, of best-selling plans gender rate, for example, charging 40-year-old women more than 40-year-old men for coverage. Only 3 percent of these plans cover maternity services.
  • Based on an average of currently advertised premiums and the most recent data on the number of women in the individual health insurance market, the practice of gender rating costs women approximately $1 billion a year.
  • There is such wide variation in differences women are charged both within and across states — even with maternity care excluded — that it is difficult to see how actuarial justifications could explain the difference. For example, one plan examined in Arkansas charges 25-year-old women 81 percent more than men for coverage while a similar plan in the same state only charges women 10 percent more for coverage than men.

That was two years ago. Mercer's data — from 2013 — provides a window into how well the PPACA addressed such inequities in its first full year. The short answer: Not very well, especially when another factor — the gender gap in pay — is factored into the equation.

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Mercer's research compared companies with workforces that are predominantly female against others that are predominantly male (65 percent was the trigger). It found the mostly female workforces pay on average 13 percent more for single coverage than their male counterparts. Their policies include deductibles that are 31 percent higher than mostly male workforces. The data considered came from 1,700 employers.

Next, the research took at look at the average pay of the mostly male vs. mostly female workplace.

"Not surprisingly, when the workforce is mostly female, the average salary is about $10,000 less than when the workforce is mostly male," Mercer's Alyssa Grabfield said in a blog post.

"Pay and benefits tend to go hand in hand," Grabfield wrote. "The health benefits at organizations with predominantly female workforces are also less generous than in those with predominantly male workforces. Because women generally use health services more than men, the disparity in benefit levels has an even greater financial impact."

Other findings from this study:

  • For coverage in a PPO the monthly contribution for family coverage is 31 percent higher for women;
  • The average in-network PPO deductibles in mostly female companies are $727 and $1,614, respectively, for individual and family coverage, compared to $557 and $1,318 at mostly male companies;
  • Mostly male companies are also more likely to offer retiree medical benefits: 27 percent offer medical coverage to pre-Medicare-eligible retirees, compared to just 19 percent of the mostly female companies.

Given these disparities, Grabfield had some advice for employers with a high percentage of female workers.

Currently, about a third (36 percent) of companies with mostly female workforces do not provide coverage to all employees working an average of 30 or more hours per week. They will be required to do so in 2015," she said.

"It is important for all employers, and especially those with largely female workforces, to understand the difference in how men and women use health benefits to ensure that plans meet their needs in an affordable manner. One solution may be to offer a range of choices that allow workers to choose between plans with lower premium contributions and higher deductibles, and plans with higher up-front cost but lower cost sharing. Thoughtful dependent coverage tiers and salary-based contributions can also address equity concerns. Because women use health benefits more, it stands to reason they value them more. For employers with a mostly female workforce, the right health benefit package might be the key to a more engaged, productive and loyal workforce."

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Dan Cook

Dan Cook is a journalist and communications consultant based in Portland, OR. During his journalism career he has been a reporter and editor for a variety of media companies, including American Lawyer Media, BusinessWeek, Newhouse Newspapers, Knight-Ridder, Time Inc., and Reuters. He specializes in health care and insurance related coverage for BenefitsPRO.