Understanding Preventative Care Under the Affordable Care Act
The Affordable Care Act, passed in 2010, made significant strides in health care by ensuring that preventative care is fully covered in all plans under the Act. This includes employer-sponsored group health plans, Federal Employees Health Benefits (FEHB) plans, and individual plans through the Healthcare Marketplace. With chronic disease being a leading cost driver in U.S. health care, effective preventative care is the most powerful tool for preventing, managing, and mitigating these conditions. Beyond reducing the prevalence of chronic diseases, consistent preventative care also contributes to improved overall health, increased workplace productivity, and decreased overall healthcare costs.
The Affordable Care Act has listed a comprehensive set of preventative services recommended by medical professionals, which are periodically updated to incorporate the latest scientific and medical knowledge. When a new preventative service is endorsed, it must be included in all applicable health plans without any member cost-sharing.
Preventative care includes specific services for men, women, and children, routine vaccinations, among other services listed below:
- Abdominal aortic aneurysm screening
- Alcohol misuse screening and counseling
- Aspirin use
- Blood pressure screening, cardiovascular disease screening, cholesterol screening, and statin preventative medications
- Colorectal cancer screening
- Depression screening
- Diabetes screening
- Fall prevention
- Hepatitis B screening
- Hepatitis C screening
- HIV screening
- Lung cancer counseling and screening
- Medical nutrition therapy, for adults with diabetes, renal disease, or who have had a kidney transplant
- Obesity screening and counseling
- Sexually transmitted infection prevention counseling
- Syphilis screenings
- Tobacco use screening
- Tuberculosis screening
If you have had a preventative service complete and received a bill, it can be for one of the several reasons, including:
- A preventative test turned diagnostic. This is common in colonoscopies. If the doctor finds a polyp or other abnormality in a colonoscopy, the colonoscopy could become a diagnostic test, resulting in a charge.
- You or your doctor discussed something that was not preventative. If you schedule a preventative doctor’s visit, know that if you bring up an issue that is not preventive, that may be coded in your medical record and result in a charge for the visit.
- You were out of network. Preventative care is only required to be covered at no charge if you are in-network. If you are seeing an out of network provider or received services at an out of network facility, you may have some cost sharing.
Tips for Navigating Preventative Care
- Consult Your Doctor: Discuss what is considered preventative for your age group and schedule those services accordingly.
- Ask Questions: Know that it is acceptable to ask questions. If you are in a preventative visit and you or your doctor brings up an issue and you aren’t sure if it’s preventative, it is acceptable for you to ask if it will be covered under your preventative visit.
- Review Your Bills: If you are billed for a preventative service or visit, call your doctor to ensure it was coded correctly.
Leveraging these tips can help you maximize your preventative care benefits, allowing you to maintain your health proactively while managing healthcare costs.
Seek Expert Assistance
Looking for insurance coverage or to maximize your current FEHB benefits? Our specialists are well-versed in the intricacies of coordinating healthcare coverage. Contact a United Benefits Specialist today to ensure your health and finances are safeguarded by your coverage.