Here is a good article for clarification of what constitutes Preventive
Services under PPACA. From our friends at Roger’s Benefit Group.
Stay Healthy, Save Money with Preventive Services Covered at 100% under Health Care Reform
Preventive health care–including annual physical exams, screenings, and immunizations–is essential to good health. Yet many Americans don’t receive the regular preventive care they need, despite the fact that chronic diseases, which are responsible for 7 of 10 deaths among Americans each year and account for 75% of the country’s health care spending–are often preventable.
Why do so few Americans get the preventive care they need? Often, the reason is cost.
The Affordable Care Act (www.healthcare.gov) (health care reform) attempts to
address this problem by requiring all new group and individual health insurance plans as
of September 23, 2010 to pay 100% of the costs for preventive care services ranked A
and B by the U.S. Preventive Services Task Force.
If your health plan qualifies, you can take advantage of a wide range of preventive care
services to help you avoid illness and improve your health–at no cost to you, so long as
you receive these services from a health care provider within your health plan’s network
of doctors and hospitals. You won’t have to pay a copayment at the office visit, and not a penny toward coinsurance or your deductible. Doctors and health care facilities continue to charge for these services. But now it’s the health insurance companies that pay the costs. Essentially, preventive care becomes ‘free’ for the policyholder, greatly increasing the incentive to take advantage of these services. The following lists outline the preventive care services covered by these rules for adults, women, and children. (I would like to add to this article that Preventative Care is NOT free!! We will all pay higher premiums because of this mandated coverage).
Covered preventive services for adults include:
• Abdominal aortic aneurysm : A one–time screening for men of specified
ages who have ever smoked
• Alcohol misuse screening and counseling
• Aspirin use for men and women of certain ages
• Blood pressure screening for all adults
• Cholesterol screening for adults of certain ages or at higher risk
• Colorectal cancer screening for adults over 50
• Depression screening for adults
• Type 2 diabetes screening for adults with high blood pressure
• Diet counseling for adults at higher risk for chronic disease
• HIV screening for all adults at higher risk
• Immunization vaccines for adults (recommendations vary):
- Hepatitis A
- Hepatitis B
- Herpes zoster
- Human papillomaviruso
- Influenza (flu shot)
- Measles, mumps, rubella
- Meningococcal
- Pneumococcal
- Tetanus, diphtheria, pertussis
- Varicella
• Obesity screening and counseling for all adults• Sexually transmitted infection (STI) prevention counseling for adults at higher risk
• Tobacco use screening for all adults and cessation interventions for tobacco users
• Syphilis screening for all adults at higher risk
Covered preventive care services for women, including pregnant women, include:
• Anemia screening on a routine basis for pregnant women
• Bacteriuria urinary tract or other infection screening for pregnant women
• BRCA (breast cancer gene) counseling about genetic testing for women at higher risk
• Breast cancer mammography screenings every one to two years for
women over 40
• Breast cancer chemoprevention counseling for women at higher risk
• Breastfeeding comprehensive support and counseling from trained
providers, as well as access to breastfeeding supplies, for pregnant and
nursing women*
• Cervical cancer screening for sexually active women
• Chlamydia infection screening for younger women and other women at
higher risk
• Contraception : Food and Drug Administration–approved contraceptive
methods, sterilization procedures, and patient education and counseling,
not including abortifacient drugs*
• Domestic and interpersonal violence screening and counseling for all
women*
• Folic acid supplements for women who may become pregnant
• Gestational diabetes screening for women 24 to 28 weeks pregnant and those at high risk of developing gestational diabetes*
• Gonorrhea screening for all women at higher risk
• Hepatitis B screening for pregnant women at their first prenatal visit
• Human immunodeficiency virus (HIV) screening and counseling for sexually active women*
• Human papillomavirus (HPV) DNA test : High–risk HPV DNA testing every three years for women age 30 or older* with normal cytology results
• Osteoporosis screening for women over 60, depending on risk factors
• Rh blood incompatibility screening for all pregnant women and follow–
up testing for women at higher risk
• Tobacco use screening and interventions for all women, and expanded counseling for pregnant tobacco users
• Sexually transmitted infections (STI) counseling for sexually active women*
• Syphilis screening for all pregnant women or other women at increased risk
• Well–woman visits to obtain recommended preventive services for women under 65*
Note: Services marked with an asterisk (*) must be covered with no cost–sharing in plan
years starting on or after August 1, 2012.
Covered preventive care services for children include:
• Alcohol and drug use assessments for adolescents
• Autism screening for children at 18 and 24 months
• Behavioral assessments for children of all ages
• Blood pressure screening for children
• Cervical dysplasia screening for sexually active females
• Congenital hypothyroidism screening for newborns
• Depression screening for adolescents• Developmental screening for children under age 3, and surveillance throughout childhood
• Dyslipidemia screening for children at higher risk of lipid disorders
• Fluoride chemoprevention supplements for children without fluoride in their water source
• Gonorrhea preventive medication for the eyes of all newborns
• Hearing screening for all newborns
• Height, weight, and body mass index measurements for children
• Hematocrit or hemoglobin screening for children
• Hemoglobinopathies or sickle cell screening for newborns
• HIV screening for adolescents at higher risk
• Immunization vaccines for children from birth to age 18 (recommendations vary):
- Diphtheria, tetanus, pertussis
- Haemophilus influenzae type B
- Hepatitis A
- Hepatitis B
- Human papillomavirus
- Inactivated poliovirus
- Influenza (flu shot)
- Measles, mumps, rubella
- Meningococcal
- Pneumococcal
- Rotavirus
- Varicella
• Iron supplements for children ages 6 to 12 months at risk for anemia
• Lead screening for children at risk of exposure
• Medical history for all children throughout development
• Obesity screening and counseling
• Oral health risk assessment for young children
• Phenylketonuria (PKU) screening for this genetic disorder in newborns
• Sexually transmitted infection (STI) prevention counseling and
screening for adolescents at higher risk
• Tuberculin testing for children at higher risk of tuberculosis
• Vision screening for all children
It’s important to keep in mind that while the health plan cannot charge you a
copayment, deductible, or coinsurance when the primary purpose of the office
visit is the recommended preventive care service and the service is NOT billed
separately from the office visit, you may be required to share some of the costs if
the preventive service is not the primary purpose of the office visit. And
remember, preventive services are covered at 100% only when received from
health care providers within the health plan’s network.
For the most up–to–date list of covered preventive care services, please visit
http://www.uspreventiveservicestaskforce.org.
