Health Care Reform and Preventive Care Costs: What Is Free?

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Updated: 11/02/2011 10:24 am

As a result of the Affordable Care Act, many health insurance plans are now required to pay in full for preventive health services, such as well visits and routine checkups.

WebMD readers have asked many questions about preventive care and the services now available as a result of health care reform. Here are answers to the five most commonly asked questions.

Q: Do all health plans have to provide free preventive care?

A: No. Insurance plans that were already in place when health reform became law on March 23, 2010, are considered grandfathered and won't be required to comply with a number of provisions of the new law.

However, the expectation is that most health plans will lose their grandfathered status due to significant changes in their benefit design by 2014 and be required to comply with all aspects of the new law.

Q: Does health care reform include provisions to reward good health behaviors, such as fitness, weight loss, and regular preventive screenings?

A: Yes. One way the new law rewards people for healthy behaviors is through employer-sponsored wellness programs. Common wellness programs offered by employers include smoking cessation, nutrition, disease counseling, and stress management.

By 2014, the law will allow employers to increase employee incentives for participating in wellness programs from the current 20% to 30% of the total premium. For employees, that can translate to money in your pocket in the form of reduced insurance premiums, lower co-payments and deductibles, gift cards, and even cash.

Q: Can we count on free preventive care, or is everything in limbo?

A: Ever since the Affordable Care Act was passed in March 2010, there has been much talk about repealing the law -- and in January 2011, the House of Representatives voted to repeal the Affordable Care Act. That has many Americans confused, believing that the health care reform law was overturned and that access to free preventive care, among other benefits, has been lost.

Nothing could be further from the truth. The law is still in place.

While lawmakers can hold up money for aspects of the law that have yet to be implemented, repealing the entire law or even specific consumer protections, such as preventive care, is not likely.

Q: Where can I find a list of all the preventive services that are covered?

A: Routine doctor visits such as annual checkups and well baby and child visits must now be covered by your insurer if they aren't already. Also covered are flu shots and a host of other vaccinations, including those for hepatitis A and B, human papillomavirus (HPV), measles, mumps, rubella, tetanus, and diphtheria.

Blood tests to identify diabetes, blood pressure and cancer screenings, smoking cessation treatment, depression screening, and diet counseling are also covered, with no deductable, co-payment, or coinsurance required.

You can find a full list of preventative services insurers must cover under the new law on the covered preventative services page at healthcare.gov.

Q: Are there any situations in which I might be charged for a wellness visit?

A: Yes.It’s important that you understand your specific benefit plan and the rules you must follow in order to have your care paid for.

For example, if your insurer has a network of health care providers through which you are required to get care, or you pay less out-of-pocket costs when you go to a doctor in the network, you may be required to share in the cost of a wellness visit if you go to a physician not contracted with your plan.

In addition, you must see your doctor for the specific purpose of preventive care in order to have the visit paid for in full. If you have a screening or blood test done during a visit to your doctor that is for medical reasons other than prevention, you will likely have to share in some of the cost.

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