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What do the new rules about preventive services in the health care reform legislation mean for you?


What Preventive Services Does the Affordable Care Act Cover?

Preventive care saves lives and saves money. However, we tend to postpone health matters that don't have some degree of urgency, or we may not want to pay to go to the doctor when we're well. According to the White House, even a small co-pay reduces the chances of people seeing their doctors. For that reason, our health care system focuses more on treating the sick, as opposed to keeping us well.

As part of the Affordable Care Act, new rules will hopefully keep more Americans from becoming ill in the first place. For new health plans that begin on or after Sept. 23, 2010, the policy must cover certain preventive care services without any sort of customer cost-sharing -- that means no co-pay, no coinsurance, no deductible.

The preventive services covered under these new regulations fall into four main groups:

  • Evidence-based preventive services. The U.S. Preventive Services Task Force, an independent panel of health care experts that was first convened in 1984, evaluates the efficacy of preventive health treatments and diagnostic tools. Any service that they've assigned the letter grade A or B to will be covered. Grade A or B recommendations include mammography, screenings for a wide variety of conditions (including cervical cancer, colorectal cancer, depression, diabetes, HIV and osteoporosis) and a wide array of counseling services, including counseling about diet and obesity, tobacco use and alcohol use. (Some of the recommendations are dependent on the age of the patient.)
  • Routine vaccinations. Vaccines covered by the new regulations will be approved by Advisory Committee on Immunization Practices. The list includes standard childhood immunizations, flu shots, the HPV vaccine and tetanus shots.
  • Prevention for children. Insurance companies will be required to cover the service recommendations outlined by the Health Resources and Services Administration, which include regular well -baby and well-child checkups. Children will also receive services including body mass index (BMI) measurements, vision screening, hearing screening, autism screening, behavioral assessments and oral health counseling.
  • Prevention for women. These guidelines, which are being developed by doctors, nurses and scientists working with the U.S. Preventive Services Task Force, will be released by Aug. 1, 2011. Of particular interest to women's interest groups is whether birth control will be covered by the guidelines.

For a full list of the preventive services covered by the new regulations, please visit HealthCare.gov. The list will be regularly updated as medical advances occur.

If you're confused about how this will apply to your particular health care plan, check with your provider. Some insurance plans already offer excellent preventive services coverage, and some insurance plans won't have to change their regulations because they have grandfathered status. That means they will be able to continue to charge co-pays or deductibles for preventive care, though they may opt to follow the new regulations. Medicare beneficiaries will see the changes take place on Jan. 1, 2011. For some people, though, the changes will have an immediate effect: If you enroll in a plan that begins on or after Sept. 23, 2010, though, then you should be able to get a mammogram or have your child immunized at no out-of-pocket cost.


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