IS YOUR HEALTHCARE CONSIDERED PREVENTIVE?

Although the Affordable Care Act (ACA) requires health insurers to cover most preventive care, the definition of this term remains unclear.

"A lot of consumers, doctors, and pharmacists don't know what's required,” says Judy Waxman, vice president of health and reproductive rights with the National Women's Law Center.

To avoid surprise costs, healthcare experts recommend that you:

  1. Know what’s covered: Under the ACA, insurance companies must cover the full cost of many preventive services, including vaccinations, cancer and other health screenings, annual well visits, breast pumps, and all FDA-approved contraceptives, based on input from a nationwide panel of primary care experts. (For a list of services covered, go to http://www.healthcare.gov/what-are-my-preventive-care-benefits).
  2. Know how your insurance company interprets these guidelines. For example, because mammograms are recommended for women over 40 every one or two years, some insurers will pay for the test annually, while other will only do so every other year.
  3. Stay in your health plan's provider network. Once you see a doctor who doesn't participate in your plan, you'll be subject to costs, even if the visit is for a preventive service that the law requires insurers to cover in full.
  4. Get to the bottom of unexpected bills. If you’re billed for a service you thought was preventive and covered in full, begin by calling your doctor’s office and then go to your health plan. If that doesn’t work, you can appeal to an independent third party. For a tool kit on preventive services, including sample appeals letters, go to The National Women's Law Center, http://www.nwlc.org.

To learn more about this key issue, feel free to get in touch with our health insurance professionals at our agency.

Need insurance for You, Your Family or Your Business?
We can match you to a qualified, local insurance expert!
Further Reading
Lacks Enterprises decided in January 2014 to open two health care clinics for their 5,161 employees and dependents. One year later, the company reported a 35 percent decrease in employee payroll contributions. As important, employees are now more act...
A "company" is sort of a weird concept, isn't it? On the one hand, a company is just a name, a brand that has earned some trust with the public. If Coca-Cola lost all of its funding and all of its bottling plants right now, they could hand the name a...
Most employers offer health insurance as part of their employee benefits package. However, don't sign up for your employer's insurance until you visit the Healthcare Insurance Marketplace at healthcare.gov. This one-stop-shop for health insurance ...
Although searching for the prices of health care has traditionally been an exercise in frustration, it's getting easier and easier to find this information. With health care costs rising and consumers on the hook for a growing share of their medic...
Cafeteria plans are being altered at most companies thanks to the new rules issued by the Internal Revenue Service. If employees enroll their eligible dependents on their health insurance plans, the new cafeteria plan rules allow those employees to m...