New health insurance plans must cover preventative services and there cannot be “cost sharing” – in other words, no co-pays or co-insurance for preventative services.
From the Health and Human Services website, here are some examples of what is covered, without co-pays, co-insurance, or deductibles.
Make sure the doctor’s office bills you correctly for “Preventative” services. If you see the doctor for preventative services only, you should not see a bill. We suggest that if you go to see the doctor for preventative services, do not talk about or have any other services performed. This way, your FREE preventative service will remain free and you should not see a bill.
Be Careful to Stay Within Your Network for Preventative Care
Those preventative services rated an A or B rating from the U.S. Preventative Services Task Force:
Children (0-17): Coverage includes regular pediatrician visits, vision and hearing screening, developmental assessments, immunizations, and screening and counseling to address obesity and help children maintain a healthy weight.
Women (18-64): Coverage includes cancer screening such as pap smears for those ages 21 to 64, mammograms for those ages 50 to 64, and colonoscopy for those ages 50 to 64, recommended immunizations such as HPV vaccination for those ages 19 to 26, flu shots for all adults, and meningococcal and pneumococcal vaccinations for high-risk adults, healthy diet counseling and obesity screening, cholesterol and blood pressure screening, screening for sexually-transmitted infections and HIV, depression screening, and tobacco-use counseling. For plan years (in the individual market, policy years) beginning on or after August 1, 2012, additional preventive services specific to women, such as well-woman visits, screening for gestational diabetes, domestic violence screening and counseling, prescriptions, FDA-approved contraception, must be covered with no cost sharing.
Men (18-64): Coverage includes recommended immunizations such as flu shots for all adults and meningococcal and pneumococcal vaccinations for high-risk adults, cancer screening including colonoscopy for adults 50 to 64, healthy diet counseling and obesity screening, cholesterol and blood pressure screening, screening for HIV, depression screening, and tobacco-use counseling.
**PLEASE NOTE – If your doctor bills 2 separate bills for your one visit, you will be billed for the portion of the office visit that was not preventative. For example, if you see a doctor for a routine physical, and in the same visit you need your prescription refilled, IF the doctor bills 2 separate bills for that visit, the physical will be free, but the prescription refill portion of that visit will be charged. IF the doctor bills everything on 1 bill, you will not be charged. We suggest that if you go to see the doctor for preventative services, do not talk about or have any other services performed. This way, your FREE preventative service will remain free and you should not see a bill.
Be careful to stay within your network for preventative care.
Recent Posts
Health Insurance Plans for Year 2019 and Beyond
According to a recent study, health insurance premiums could increase for individual plans on the ACA marketplace between 35 and 94 percent by 2021. Concern over health care is nothing new; in fact, this is the fifth consecutive year that Americans have ranked health care as a top concern.
Health Insurance Could Become The Wild Wild West Once Again
At least for now, many aspects of ACA are still in place. Currently, an insurer can’t turn you away for a pre-existing condition, and long-term health insurance plans still have to provide coverage for ACA’s 10 essential health care benefits. Prior to 2010, private health insurance usually did not cover maternity, or preventative like it does now, and mental health was generally non-existent.
Repeal of the Individual Mandate
Health insurance, which has always been a topic surrounded by confusion, is doubly complicated as coverage requirements have evolved in recent years. Among the most significant changes was the individual mandate that was put into place under the Obama administration.