61
uhc_video
Welcome to Health Care Reform Demystified. Today’s episode: Preventive Care Coverage under the Affordable Health Care Act.
There’s an old saying about preventive medicine – an ounce of prevention is worth a pound of cure. This obviously doesn’t work with actual weights. But, it’s an accurate expression of value that holds true for health care today. Routine checkups and preventive services may help people avoid serious health problems and maintain their health. That’s why the Affordable Health Care Act includes a provision to make certain important preventive services available without having to pay copays, coinsurance or deductibles.
Some examples of preventive services covered by this provision include well baby and well child care, blood pressure, diabetes and cholesterol screenings, screenings for health issues such as smoking, depression and alcohol abuse, routine vaccinations and immunizations, and even hearing screenings. The provision also covers screening mammograms and screening colonoscopies. Sorry, no visual aids for those.
One important thing to note is that a procedure can be considered preventive care in some situations, but not in others. This is important because a service has to be considered preventive in order to be exempt from copays, coinsurance, or deductibles. If it’s not, these charges may apply.
To help make sense of this, let’s play a quick round of “Preventive? Or Not Preventive?” I’ll describe a situation, and you tell me whether or not it’s an example of preventive care. Yes, I know I can’t actually hear you. Just play along. Here’s the first situation: A woman visits her doctor in the network for an annual mammogram. Preventive? Or, not preventive? Correct answer is preventive because her visit is part of a routine annual exam, and not because she had a previous diagnosis. Simple enough, right
Okay, how about this, a woman visits a doctor in her network for a mammogram, but the results prompt the doctor to ask her to come back in six months for a follow-up visit and a follow-up mammogram. In this case, the first mammogram is considered preventive, but the second is not. The second mammogram, which is done much sooner than a screening mammogram and any additional tests would be considered treatment for a diagnosed condition.
Let’s try another one. A man receives a blood test to measure his cholesterol level at his annual wellness exam. In this case, the office visit and the blood test are considered preventive care because the patient who is being screened has no known symptoms, illness or injury.
With me so far? Let’s do one more. A man makes quarterly visits to his doctor for blood tests to check his cholesterol level to confirm the medication dosage is appropriate. Because they are part of a treatment regimen for an existing condition, the quarterly blood tests are not preventive care.
So, let’s review the basics and cover a few more considerations on preventive care.
The Affordable Care Act makes certain preventive services available to most plan members without copays, coinsurance, or deductibles. To be covered without member cost-sharing, the tests, examinations and other medical services must be preventive and not part of a diagnostic procedure or on-going treatment for an existing condition.
If a plan includes a network of providers, the elimination of copays, coinsurance and deductibles for certain preventive services applies only to in-network providers. In fact, some plans may not cover preventive services that are received out of network at all.
Vitamins, nutritional supplements, aspiring, over the counter medications, fitness classes and health club memberships are not considered preventive care services. These services are not covered at all. Some grandfathered health plans are exempt from the preventive services provision.
Well, it’s long been said that one of these (apples) a day keeps the doctor away. Taking advantage of routine preventive care services is a much better bet for long-term health and wellness.
Health Care Reform Demystified
Health Care Reform Demystified: Preventive Care
With U. Horace Cartwright
The Affordable Care Act contains a provision to make certain preventive services available without co-pays, co-insurance or deductibles. This helpful explanation shows how it works.
Please enter a valid email address
