Health Insurance 101: Preventative Care - Care At No Cost

Health insurance terms are sometimes hard to understand.  This is partially because we don’t spend much time talking and learning about them and partially because insurance companies present, explain, and sometimes even define them all differently.  This series will help you understand what important health insurance terms mean so you can better choose your health insurance coverage.

With the passing of the Patient Protection and Affordable Care Act (Health Care Reform), insurance companies are required to cover preventive care services at no cost. 

Specifically:

Under the regulations, plans must cover without copay, coinsurance, or deductible, certain preventive services that have strong scientific evidence of their health benefits.

Translation:

If you have insurance coverage, you are eligible for certain preventive care services at no cost. There are no co-pays, you don’t have to meet a deductible, and you won't  receive a lab bill in the mail three weeks later. There is no cost at all.

But what’s covered?

Health insurers, when describing what preventive services are available at no cost, use general terms like ‘preventive care’, or specific terms like physicals, ob/gyn, and well-baby visits. These descriptions leave out other types of preventive care that are covered. 

The end result: Patients don’t understand what types of preventive services are available at no cost. 

Here’s a guide to help you understand what preventive care is available and how to ensure you don’t pay for it.

Pre-authorization:

Before getting any type of medical care or service, it’s good to get that test or procedure approved by your insurance company. To do this, when you set the appointment, be specific about why you are coming in and have your doctor’s office coordinate with your insurance company to get the pre-authorization.  This way, if something is not covered, you will know in advance.

Covered Preventive Care for Children and young adults:

• Post-partum visits and screenings for newborns. 
• Various immunizations required throughout childhood. 
• Autism screenings at 18 and 24 months. 
• Vision screenings and oral health risk assessments. 
• Obesity screening and weight management counseling (children age 6 and older).
• Depression screenings.
• Alcohol and drug assessments.
• STD testing and counseling for young adults at high risk.
• More…

Covered Preventive Care for Adults:

• Blood pressure screenings for all adults.
• Cholesterol screenings for men age 35 and older and woman age 45 and older.
• Diabetes type 2 screenings for adults with high blood pressure.
• Mammograms every 1-2 years for women over 40.
• Prostate cancer (PSA) screenings for men.
• Health counseling for obesity, tobacco use, alcohol abuse, depression, and STD prevention.
• Nationally recognized, non-travel-related immunizations.
• Certain screenings, counseling, and supplements for pregnant women.
• More…

The full list is exhaustive, but knowing that preventive care includes more than physicals, ob/gyn, and well-baby visits will help you better understand the concept of preventive care so can utilize it more often without incurring any costs.

Here is the full list of covered preventive services.

Image: a.drian, Creative Commons Attribution-NoDerivis 2.0 Generic