One of the first implemented tenets of the Affordable Care Act was to give insured Americans access to free preventive care. But more than four years after this policy began, many people are still unaware of these preventive health benefits or how to take advantage of them.
The Department of Health and Human Services estimates the ACA rule made 76 million Americans “newly eligible” for free preventive care. But a Kaiser Health Tracking Poll in March 2014 revealed that only 43 percent of the population were aware of the change, meaning many are likely to avoid such care out of cost concerns.
What Is It?
Section 2713 of the ACA mandates all individual and group health plans offer a list of preventive care benefits with no cost-sharing requirements passed onto the consumer.
Technically, the services aren’t free – they’re paid for by the health insurance company through the money collected in your monthly premium – but you cannot be charged a copay, coinsurance or deductible to take advantage of them. In other words, you pay nothing at the time of service.
The exception to this mandate is health insurance plans that are grandfathered – which is to say they existed before March 23, 2010. According to the Kaiser Family Foundation, this includes more than one-fourth of workers covered by employer-based insurance as of 2014.
What Services Are Included?
The list of preventive services available with no cost sharing is lengthy. You can view them in their entirety at HealthCare.gov. For adults, there are 15 basic services, including:
- Alcohol and tobacco misuse screening and treatment options
- Blood pressure and cholesterol screenings
- Obesity and Type 2 diabetes screenings
- Depression screening
- Colorectal cancer screening
For children, the list is 26 items long and includes:
- Developmental screenings
- Autism screening
- Depression screening and behavioral assessments
- Vision and oral health screenings
Preventive services specifically for women are available on plans beginning on or after Aug. 1, 2012. These include 22 preventive services such as:
- Well-woman visits
- Osteoporosis and anemia screenings
- Prenatal care
- Mammograms and breast cancer counseling
How Often Can You Take Advantage of Them?
You can take advantage of most of these preventive services when you go in for a yearly physical or, in the case of women, your well-woman visit.
Obviously, timetables for immunizations differ from vaccine to vaccine, and your doctor can provide guidance on how often you should be receiving shots.
When Free Isn’t Free
As with nearly every health insurance benefit, there are exceptions, or rather words of warning that should accompany the invitation to avail yourself of them.
Your doctor’s office may bill a visit separately from your preventive services. If this is the case, you might have a copay. You might also have to pay if the primary reason for your appointment is something other than preventive care.
You’ll also likely have to pay out-of-pocket for treatments and follow-up appointments with your doctor if those screenings reveal a problem.
For instance, your child’s developmental or depression screening could reveal areas of concern, but any treatment for these findings would likely be subject to the deductible and other cost-sharing aspects of your health insurance plan. So following up with a specialist or mental health counselor could cost you.
Further, health insurance companies are handling the requirements differently.
In the case of free contraceptives for women, insurers are only required to offer one type of contraceptive from several different groups, and some see this as an opportunity to save money. So, if you want a vaginal ring, but the insurer offers alternative methods also considered “hormonal birth control,” you could be stuck with a bill. Likewise, opting for brand name over generic could leave you with cost-sharing responsibilities.
Finally, if you go to a provider outside of your health insurance network, your preventive care likely won’t be free. As with all medical services, you stand to save more when you seek in-network providers.
The Best Advice: Ask
When you schedule an appointment for any free preventive services, make it known that you’re interested in getting your free preventive screenings and want to be told if any services fall outside the list of approved “free” services.
If you’re visiting your doctor, don’t be afraid to speak up when he or she recommends additional testing and treatment. If they aren’t covered, you’ll need to pursue those recommendations with the knowledge that you’ll likely have some cost-sharing responsibilities.
While your doctor should have a general idea of which screenings and services fall under free preventive care, you can also call your insurance company for clarification.