Individual health plans purchased through the marketplace must now cover a certain set of preventive care services at no additional cost to the individual. This means that if you have a health plan and choose to take advantage of one of these services, your health insurance provider will absorb the entire cost of care.
This ACA provision has made dozens of procedures and screenings attainable for millions of Americans. However, there are still millions of people who don’t know about or don’t understand preventive care services. In March 2014, it was reported that only 43 percent of the population understood that the Affordable Care Act eliminated out-of-pocket expenses for preventive care services.
In addition, many people have chosen to completely forgo important procedures. In 2014, 20 percent of women postponed a preventive care service to avoid high out-of-pocket costs. This means that many women could be skipping regular mammograms, an essential procedure that can detect life-threatening breast cancer. Not taking advantage of preventive care services now could mean costly medical care later on.
In an effort to educate Americans about their coverage and encourage them to enroll in a plan if they have yet to do so, we have outlined the various preventive care services and how you can take advantage of them to better your health.
What are the specific preventive care services?
There are many options available, but all preventive care services fall into one of four major categories:
- Evidence-based screenings and counseling
- Preventive services for women
- Routine immunizations
- Preventive services for children and young adults
Within each of those categories, there are 15 covered preventive services for adults, 22 covered preventive services for women (including pregnant women), and 26 covered preventive services for children and young adults.
In the adult category, some of the most commonly desired services are depression screenings, colorectal cancer screenings for adults over 50, and various immunization vaccines. Tobacco screenings and diet counseling are also covered.
For women, the services get a little more specific. Mammograms are covered every one to two years for women over 40, and BRCA test counseling and cervical cancer screenings are also covered. Although this one can vary, contraception – including birth control, sterilization, and education and counseling – is also considered a preventive care service. Arguably most important for the majority of women, well-woman visits are also covered.
Children and young adults can also take advantage of a wide range of preventive care services. Autism, vision, and depression screenings, immunization vaccines until age 18, and regular checkups until age 17 are all covered to aid in healthy youth development.
Preventive care services are free. Why did I still get charged a fee?
Preventive services are often described as “free,” but it’s important to watch out for details of treatment that may end up leaving you with a bill.
Additional lab work or screenings may be the cause of your out-of-pocket expenses. You may hear your doctor mention sending samples out to a lab for additional testing, and this is where medical costs can start to add up. Not all external lab testing is covered as a preventive care service.
You may also receive treatment based on a preventive care service visit, but that treatment may not necessarily be included and might result in cost-sharing. For example, although a colonoscopy is covered as a preventive care service, polyp removal during the procedure is not.
Another possibility is that the lab may have billed you for a service that actually should have been covered. If a mistake is evident or if you’re unsure why you owe money, call your doctor or the lab directly to follow up.
Can I receive preventive care services from any physician?
When taking advantage of preventive care services, it’s important to try and visit a doctor within your network. This stipulation can get a bit tricky, though: If there is no in-network physician available to perform the preventive care service, then an out-of-network provider may be consulted and you will not be billed. However, if you choose to go to an out-of-network provider when an in-network provider is available, you may be billed for the visit and the preventive care services performed.
To avoid any unnecessary out-of-pocket expenses, it’s best to first check if there is an in-network provider available to you. If there is, visit that physician to avoid charges.
Preventive care services are important for everyone, but the only way you can take advantage of them is if you are enrolled in a qualified health plan. If you are still uninsured, you may still have until April 30 to get covered. Once you find a plan, you can start taking advantage of preventive care services available to you.