One way to help lower medical expenses is to prevent them, but many people have been hesitant to get preventative checks and treatments due to the cost. Healthcare reform was introduced to lower the cost of healthcare for those who cannot afford it, and under the Affordable Care Act patients may now be eligible for some very important preventative care services for free.
Every insurance plan is different, so it is important to verify whether a plan qualifies for the new preventative care services before offering them to the patient. If a plan does qualify, then the patient can be seen for certain tests and exams without co-payment, deductible, or office visit charges.
Age is another important qualifier under the new legislation. Even if a certain exam is covered under the legislation and the patient’s insurance, the patient’s age may disqualify them from having the work done at no additional cost. For example: if a 26-year-old female and a 55-year -old female would like to have a mammogram, under the new legislation, the 55-year-old would be covered for preventative care service while the 26-year-old would have to make a co-payment and possibly pay for any co-insurance cost related to the exam.
Other preventative measures that may qualify under the new legislation include:
- Blood pressure tests
- Counseling for: smoking, weight-loss, depression, and alcohol abuse
- Diabetes screenings
- Routine vaccinations
- Many cancer screenings
- Flu shots
Some important details you should know*:
- The preventive services provision applies to people enrolled in job-related health plans or individual health insurance policies created after March 23, 2010. If you are in such a health plan, this provision will affect you as soon as your plan begins its first new “plan year” or “policy year” on or after September 23, 2010.
- If your plan is “grandfathered,” these benefits may not be available to you.
- If your health plan uses a network of providers, be aware that health plans are only required to provide these preventive services through an in-network provider. Your health plan may allow you to receive these services from an out-of-network provider, but may charge you a fee.
- Your doctor may provide a preventive service, such as a cholesterol screening test, as part of an office visit. Be aware that your plan can require you to pay some costs of the office visit, if the preventive service is not the primary purpose of the visit, or if your doctor bills you for the preventive services separately from the office visit.
- If you have questions about whether these new provisions apply to your plan, contact your insurer or plan administrator. If you still have questions, contact your State insurance department.
- To know which covered preventive services are right for you—based on your age, gender, and health status—ask your healthcare provider.
*Information provided by www.healthcare.gov. Click on the link to read more information about this change.
As a medical administrative assistant, you’ll get questions about these new legislative policies since you’ll be the one who handles patients’ insurance. If you are unsure on whether the patient qualifies for no-cost preventative care services, you or the patient should contact a representative from the patient’s insurance company.