Health Care Reform Mandates Preventive Health Services
Posted Feb.23, 2011 in Health Care, Patient Protection and Affordable Care Act, Preventive Health Services
Among the features of the Patient Protection and Affordable Care Act (Health Care Reform) recently implemented, is the requirement that insurers cover a number of specific preventive health services without any additional cost-sharing requirements.
The law is designed to encourage individuals to get exams, screenings, and tests that detect health problems in their early stages. And while the law can’t get people to go get the recommended check-ups and tests, it is meant to remove their hesitations over cost by disallowing deductibles, co-payments, or co-insurance for the specified services.
At the time of passage, the legislation left blank the list of services and governing rules. Since then, the departments of Health and Human Services (HHS), Labor and the Treasury have issued regulations and a detailed description of covered services that must now be part of every plan begun after September 23, 2010. Already existing plans, where benefits and costs remain substantially unchanged from previous years, may be grandfathered and exempt.
Under the new rules, a list of routine recommended immunizations for both adults and children was adopted from the Centers for Disease Control and Prevention. The immunization list includes hepatitis A; hepatitis B; herpes zoster; human papillomavirus; influenza; measles, mumps and rubella; meningococcal; pneumococcal; diptheria, pertussis, and tetanus; and varicella.
Health care reform guidelines also include preventive care screenings for depression, alcohol misuse, high blood pressure, colorectal cancer, Type 2 diabetes, HIV, cholesterol, obesity, and syphilis. Adult men who smoke or have smoked can also receive a one-time screening for abdominal aortic aneurysms.
Women are eligible for free screenings for osteoporosis; breast cancer through mammograms; anemia; cervical cancer; hepatitis B; chlamydia and gonorrhea. Women who are pregnant can also receive screenings for Rh incompatibility and urinary tract infections.
In addition to the screenings and tests listed here, still others appear in the HHS guidelines. A complete list that was generated by the U.S. Preventive Services Task Force is available online by clicking here.
When clarifying its rules, the HHS declared that when these services are accessed through out-of-network providers, insurers may apply their usual out-of-network charges. In a related ruling, the agency determined that if a medical appointment is made for care not included in the covered list but covered care is given during the appointment, the co-payment or co-insurance may still be charged for the appointment. However, the insurer can not add an extra charge for the preventive care given during that appointment.
Finally, ProtectPlus subscribers should take note that all the preventive services newly mandated by health care reform were already covered by their plans. Though subject to some cost sharing in the past, these services are now 100% plan paid when obtained through in-network providers.
