We’ve all heard this expression: “An ounce of prevention is worth a pound of cure.”
The authors of the Affordable Care Act (ACA) are counting on that! The law requires all marketplace and non-grandfathered health insurance plans to provide coverage for certain preventive care services at no cost to the insured.
When we say at no cost, that means the services must be provided without charging coinsurance or a copayment, and whether or not you have met your annual deductible. IMPORTANT: In order to be covered at 100%, a preventive service must be obtained from an in-network provider, must not be billed separately from the office visit, and must be the main reason for the office visit.
The covered services fall into four general categories:
- Evidence-Based Screenings and Counseling – screening for depression, diabetes, cholesterol, obesity, various cancers, HIV and sexually transmitted infections (STIs), as well as counseling for drug and tobacco use, healthy eating, and other common health concerns.
- Routine Immunizations – influenza, meningitis, tetanus, HPV, hepatitis A and B, measles, mumps, rubella, and varicella.
- Childhood Preventive Services – in addition to the immunization and screening services described in the previous two categories, also covered are behavioral and developmental assessments, iron and fluoride supplements, and screening for autism, vision impairment, lipid disorders, tuberculosis, and certain genetic diseases.
- Preventive Services for Women – in addition to the immunization and screening services described in #1 and #2 above, also covered are annual well-woman visits, testing for STIs and HIV, support for breast feeding, screening and counseling for domestic violence; also covered are FDA-approved contraception methods (including sterilization procedures) as prescribed by a clinician, as well as patient education and counseling on contraception (note – plans sponsored by certain religious employers may be exempt from the contraception coverage requirement).
In addition to these preventive services, all marketplace and non-grandfathered plans must also cover certain essential health benefits.
Have a specific question about what is covered and what is not? Give us a call! We will help you figure it out!
