Are You Taking Advantage of Free Preventive Care Under Obamacare?

They say an ounce of prevention is worth a pound of cure, and perhaps nowhere is this more relevant than when it comes to our health care.

According to the Centers for Disease Control (CDC), chronic diseases that could be avoided through preventive care decrease U.S. economic output by $260 billion per year. They also monopolize 75 percent of all U.S. healthcare spending—and that’s to say nothing of the toll these diseases take on quality of life.

Sobering statistics such as these help explain why the Affordable Care Act (a.k.a Obamacare) requires private insurance plans to cover recommended preventive services with no cost to patients (meaning no copays or coinsurance) regardless of whether or not you have met your deductible.

In 2013, two years prior to the passage of the Affordable Care Act, the Kaiser Family Foundation commissioned a study showing that 20% of all women and 16% of all men postponed preventive services due to their cost. With cost barriers minimized, the hope is that more people will avail themselves of these services that can fend off needless suffering and financial burdens.

What are my options?

To ensure that you are availing yourself of covered preventive care services, we’ve compiled a list of benefits that are available for free under the Affordable Care Act. Note, however, that these services are usually only free when they are delivered by a provider who is in your plan’s network.

For adults:

Screenings for all:

• Abdominal aortic aneurysm (for men who have smoked)
• Blood pressure
• Cholesterol (for at-risk patients)
• Colorectal cancer (for adults ages 50 to 75)
• Depression
• Diabetes, Type 2 (for overweight adults ages 40 to 70)
• Hepatitis B and C
• HIV (for at-risk adults)
• Lung cancer (for adults 55 to 80 depending on their smoking history)
• Syphilis
• Tuberculosis

Screenings for women:

• Anemia
• Gonorrhea
• Gestational diabetes
• Maternal depression
• Preeclampsia (for pregnant women with elevated blood pressure)
• Rh incompatibility (for pregnant women)
• Urinary tract or other infections

Immunizations

• For diphtheria, hepatitis A/B, herpes, HPV, flu, measles, meningococcal, mumps, pertussis, pneumococcal, rubella, tetanus, chickenpox)

Counseling and support

• Alcohol misuse
• Aspirin use (doctors advise at-risk patients about the benefits of aspirin use to prevent cardiovascular disease and certain types of cancer)
• Dietary counseling
• Fall prevention (for adults 65 and older)
• Sexually transmitted infection prevention
• Tobacco cessation

Medication/Supplements

• Statins (drugs that can lower cholesterol and, consequently, the risk of heart attack and stroke)
• Folic acid for women who are pregnant or trying to get pregnant

Contraception*

• FDA-approved contraception
• Sterilization procedures
• Education and counseling

*Does not apply to health plans sponsored by exempt religious employers

For children:

Screenings:

• Alcohol, tobacco and drug use (for adolescents)
• Autism
• Behavioral
• Blood pressure
• BMI
• Cervical dysplasia (for sexually active adolescent girls)
• Depression
• Developmental (for children under 3)
• Dyslipidemia
• Hearing
• Hematocrit/hemoglobin
• Hepatitis B
• HIV (for at-risk adolescents)
• Lead (for at-risk children)
• Oral health risk
• Sexually transmitted infection
• Tuberculin
• Vision

Newborn screenings:

• Bilirubin
• Blood
• Hypothyroidism
• PKU (phenylketonuria)
• Sickle cell

Immunizations:

• Most common vaccines are covered.

Supplements:

• Fluoride chemoprevention (for children without access to fluoridated water)
• Fluoride varnish
• Gonorrhea preventive medication (for newborns)
• Iron

Counseling:

• Obesity
• Sexually transmitted infection prevention

How do I benefit from these services?

The best place to start is with your insurance provider. Find out what they offer in the way of annual physicals. While insurance providers are not expressly required to cover annual check-ups under the Affordable Care Act, many insurance companies offer them as a covered benefit, though you may need to receive it through an in-network provider.

If you are eligible for a regular physical, ensure that you get into the doctor’s office for this service. Ask them about any screenings/procedures that are appropriate to your age and adhere to their recommendations.

These may include:

• Cholesterol screening
• Colonoscopy
• Lung cancer screening (for smokers)
• Pap smear
• Mammogram
• Bone density screening
• Prostate screening

The frequency of these exams will depend on your age and risk factors. Talk to your doctor for more specific guidelines.

What about Medicare?

If you have Medicare, they do not cover an annual physical, but they do cover an “annual wellness visit.” This visit provides a chance for your doctor to examine your general health indicators (BMI, blood pressure, etc.) and review your medical history, your family’s medical history, and your risk factors for preventable diseases.

Why did I get charged for preventive care?

Perhaps you have had the experience of being billed for one of the preventive services described above. You may be wondering how this could happen if these are covered benefits. Here’s where things get a little sticky: it all comes down to preventive vs. diagnostic care.

If your doctor happens to find a problem through one of these preventive screenings (for example, if your colonoscopy reveals a polyp that your doctor removes during the procedure), your screening may be reclassified as diagnostic, and you may be billed for it. Diagnostic care includes visits, tests and procedures that diagnose and monitor a medical condition. It may include biopsies, endoscopies, x-rays, or ultrasounds.

How can I know what I will be billed for?

In a word, communicate. When you schedule a screening or procedure that you are expecting to be preventive, ask your provider’s office and insurance company what the true cost will be. Document their replies.

You should also keep a close eye on your billing. If you are charged for something that you believe was a covered benefit, don’t panic. Follow up with both your doctor and your insurance company to ensure that there were no mistakes. You can also appeal your claim if you believe that you were charged for something that should have been free to you.