Free Preventive Care!

There are some adjustments to healthcare in a post ACA world that have been difficult for many- particularly the high-deductible plans that are now so frequent (although blamed on the ACA they are actually an industry choice- but that is a future Fontenotes*)

However, we got a benefit through the ACA- something pretty great! As I don’t hear anyone talking about it- I wonder if people know? It is free preventive screening and care.

Wait! For all of us? What does “free” mean- and what does “preventive” include? And not? Of course there are many details to this.

We all love “Free” – Free almost anything! Right? But as I said- there are some details and “ifs”…

First of all- What is “free”? Getting something at no cost to you- with no copay- and it doesn’t count against the deductible you have to pay off. That is pretty free!

Some of you may not be eligible. Why?  Because your plan doesn’t comply with the ACA- yet.  The law required all insurance policies to meet “minimal essential benefits” by January 1, 2014- all plans had to step up to the newly established policy requirements or close down. This is why in the Fall of 2013 so many people got “pink slips” from their insurance company telling them they that they were getting “dumped”– ironically it wasn’t the patients that were insufficient- it was the policies.

Well- the brouhaha over people losing their insurance created a scramble- and compromise- with Washington allowing states to choose to keep these sub-standard policies alive for a few more years. Some states said “No” but others said “Yes”- with varying dates when those policies would be phased out- as late as next year (2016). So- If you are still covered under one of those policies you can stop reading now.

Now to the rest of you- Yes! Free preventive screening! Mammograms and glaucoma and depression assessments for your teens, and so much more! And not only screening- treatment as well. Immunizations, nutritional counseling, and both alcohol and tobacco cessation programs are just a few examples.

Of course not all of these tests and treatments are free for all comers– you have to have the target condition (or be at risk for a screening) and many tests are age specific (sorry kids- you will have to wait for your free colonoscopy!) But the list is quite extensive.

Perhaps best of all- for many of you an annual wellness exam with your doctor/primary provider to determine what you need is also available at no cost to you– certainly if you are a Medicare Part B beneficiary.  The rest of you will need to check your policy.

It is important to understand that the benefit extends to “preventive” care- not diagnostic screening or treatment. What is the difference? In a nutshell you get preventive screening to detect hidden conditions that are not apparent yet, diagnostic screenings when you have symptoms and your physician is trying to determine if you have a condition, and treatment when you are diagnosed with something and the treatment follows.  Similarly you may be able to get preventive care (like immunizations) for you or your child to protect from diseases or infections for free- but if either of you get sick you will need treatment- which may require a co-pay or apply to your deductible. If I just confused you there is an excellent explanation (using a colonoscopy as the example) here.

Last but not least- there may be other costs associated with your “free” screening. Using the same example as above- in obtaining a colonoscopy the test itself may be at no cost to you- but you might be charged for anesthesia, medications related to the test, and/or a facility fee. What is important is you find out in advance so you will not be surprised- which means talk to both your doctor and your insurance company (the number to call is on the back of your insurance card).

At the end of the day that might sound like many more “ifs” and a lot more work than getting something “free”- but here is my wish. In recognizing there are benefits to you I hope you take those extra steps- grasp what is yours- and get better preventive care as a result. We all earned it- we all need it- we all should claim it!

What Does This Mean?

More on “Preventive Care” How do you know if something is preventive care or treatment? United Health Care has an excellent preventive care guide that illustrates the differences- even if you have a different insurance company this guide could be very helpful in knowing what questions about coverage you should ask about your own policy.

“Minimal Essential Benefits”  The ACA is intended to do more than put insurance within reach of those previously uninsured, it is to get all Americans well insured. Insurance reform is the heart of the ACA, with the paramount goal to protect consumers from policies that do not cover all their health care needs. This can only happen if policies meet the mandated, minimum threshold for coverage. By instituting “minimal essential benefits,” the ACA seeks to standardize policies across the country. Get more information on what those minimum benefits are here.

And now my *: There are many things I want to write about- but I would much rather write what you want to read. Is there something about the Affordable Care Act- or just healthcare in our world today- that you would like to know more about? Please let me know. My Fontenotes are yours to command!