The Affordable Care Act (ACA) requires health plans to cover certain preventive services at no-cost to enrollees, yet only eight percent of adults aged 35 or older receive all their recommended services. Preventive care is a crucial step to achieving better health outcomes, early disease detection and lower health care costs. Ensure your employees are capitalizing on no-cost options by educating them on the ins and outs of preventive care.
- What is covered?
Healthcare.gov sorts preventive services into three categories, with recommendations varying based on age, sex and personal risk
factors. Recommended services must be offered at no cost even before a member’s deductible has been met. Patients should consult with a health care provider to determine which services are right for them. There are recommended
services for- adults, which include blood pressure screenings, flu, tetanus, and HPV vaccinations, colorectal screening, and diet counseling,
- women, which include birth control, breast cancer mammography and cervical cancer screenings, well-woman visits, and
breastfeeding support, - and children, which include autism and developmental screenings, fluoride supplements, measles, chickenpox, and pneumococcal
vaccinations, and well-child visit.
- Who decided what services qualify?
Three health agencies help the government determine what preventive measures are covered by the ACA provision:- U.S. Preventive Services Task Force
- Health Resources and Services Administration
- Advisory Committee on Immunization Practices (part of the Centers for Disease Control and Prevention)
- Why did a preventive service result in a charge?
Plan members may incur a charge for preventive services if the service occurs- at an out-of-network facility,
- on a different timeline than guidelines suggest,
- for diagnostic rather than screening purposes, or
- the charge is for a noncovered service that was administered at the same time as the preventive care.
Help your employees establish proactive health management habits through preventive care education. Share our Fast Facts video featuring a simple, two-minute overview explaining preventive care services.
