Health Care Reform Helps You Get Preventive Services

Maryalene LaPonsie | September 13, 2010

The recently passed federal health care reform is making waves in the way you receive medical health insurance benefits. From pre-existing conditions to subsidized premiums, you will see significant changes in your coverage. Discover whether your preventive services benefits may change as well.

You may consider your medical insurance a safety net--protection against costly hospitalizations or chronic illnesses that could leave you bankrupt or without coverage for needed treatments. While catastrophic care is certainly an important aspect of medical health insurance, don't overlook preventive services that can add up to hundreds and even thousands of dollars each year.

Fortunately, the federal health care reform bill makes preventive services a priority. To create low-cost health insurance, the government knows that it is critical to encourage healthy habits and catch small concerns before they turn into chronic problems.

How Preventive Services Discount Health Insurance

The term preventive care can refer to a wide range of medical services, such as annual physicals, prescription drug treatments, and well-child check-ups for infants. Without preventive services, easily managed conditions can become life-threatening emergencies.
For example, blood pressure can be regulated relatively easily and inexpensively with prescription drugs. However, without access to preventive services such as an annual physical, high blood pressure can be left undetected and untreated. The result may be a seizure or stroke resulting in hospitalization and possibly lengthy rehabilitation.

According to the Partnership for Prevention, a collaborative group of businesses, non-profits, and government agencies, 100,000 deaths could be avoided each year through the use of preventive services such as immunizations and cancer screenings. It is no wonder then that health care reform makes preventative services a priority as a step toward affordable health care.

Health Care Reform Changes Preventive Care Coverage

Preventive care services requirements will be phased in slowly in accordance with the health care reform legislation. Most changes occur within four years; however, some programs may not be fully implemented until later.

Within the next six months, all new group health plans and individual insurance policies must cover certain preventive services. You do not have to pay co-pays or deductibles for this care. In 2011, Medicare no longer applies co-pays or deductibles for preventive services.

By 2018, all health plans, including preferred provider organization (PPO) and health maintenance organization (HMO) policies are required to pay the full cost of preventive services.

Which Preventive Services Must Be Covered?

Under the new regulations health insurance companies are required to provide coverage for all preventative services rated Grade A or Grade B by the US Preventive Services Task Force. Recommendations are made for men and women, as well as special populations such as children and pregnant women.

The current US Preventative Services Task Force recommendations are:

For Men and Women:

  • Screening and counseling for alcohol abuse
  • Use of aspirin to prevent heart disease
  • Colorectal cancer screening
  • Depression screening
  • Counseling services to promote a healthy diet
  • High blood pressure screening
  • HIV screening
  • Lipid disorders screening
  • Obesity screening
  • Counseling for sexually transmitted diseases
  • Syphilis screening
  • Counseling for tobacco use
  • Type 2 diabetes screening

For Men Only:

  • Abdominal aortic aneurysm screening

For Women Only:

  • Breast cancer screening
  • Cervical cancer screening
  • Chlamydia screening
  • Gonorrhea screening
  • Osteoporosis screening for postmenopausal women

Additional Services for Pregnant Women:

  • Asymptomatic bacteriuria screening
  • Hepatitis B screening
  • Iron deficiency screening
  • Rh(D) incompatibility screening

For Children:

  • Congenital hypothyroidism screening
  • Dental care to prevent cavities in preschool children
  • Prophylactic medication for gonorrhea
  • Hearing screening for newborns
  • HIV screening
  • Iron deficiency prevention services
  • Depressive disorder screening
  • Phenylketonuria screening
  • Counseling services for sexually transmitted diseases
  • Sickle cell disease screening
  • Vision screening for children younger than 5 years old

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