Better Access to Preventive Care- key goal of health insurance reform

Insuring Resources Commentary:

This should go a long way toward improving health outcomes for many, many Americans, particularly for the chronically uninsured and underinsured who will now have first dollar coverage of preventive services-- no copays, deductibles, etc.





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From the NY Times
By LESLEY ALDERMAN
Published: April 9, 2010


A PRIMARY goal of the health care overhaul was to provide insurance for more people, namely those who could not afford coverage and those with pre-existing conditions for whom insurance was too costly.

But the new law also aims eventually to improve health insurance for everyone. By now you have probably read or heard about big changes like the rules that will require insurers to cover everyone who applies, regardless of health status, and forbid them from dropping people when they get sick.

You may not yet be aware, though, of another notable improvement to insurance, a change that could save a consumer or family hundreds of dollars a year. Under the new law, insurers must offer preventive services — like immunizations, cancer screenings and checkups — to consumers as part of the insurance policy, at no additional out-of-pocket charge.
The idea is that healthy Americans will be less costly Americans.

“This is transformative,” says Helen Darling, president of the National Business Group on Health, a nonprofit organization for large employers. “We’re moving from an insurance model that was based on treating illness and injury, to a model that’s focused on improving an individual’s health and identifying risk factors.”

The trend toward offering free preventive care has been gaining steam for a decade among large companies that provide employee health benefits. “Employers recognize that if they want to control costs, they have to persuade their workers to be healthier, including their children,” Ms. Darling said.

Three out of four large companies now offer free preventive health services to their workers, according to a 2009 survey by Mercer, a benefits consulting firm. Smaller employers, though, and individual health plans have been less likely to offer free care of any type.

But under the new law, more generous “wellness” benefits should eventually be available to almost all Americans with insurance.

“Eventually” is the operable word, though. Although this feature of the law goes into effect at the end of September, it will apply to new insurance policies only. That means if you switch to a different policy, or buy a new one, the preventive services will be offered.

But if you are already in a plan, your benefits probably will not be upgraded until the plan makes a significant change, like modifying its cost structure. Simply signing up again during next fall’s annual enrollment for the same coverage you now have may not necessarily cause the new preventive-care requirement to begin. Until the Department of Health and Human Services actually writes the new regulations for this and many other parts of the law, though, no one can say for certain what will count as a event that sets the preventive care requirement in motion.

A clear exception is Medicare. Starting next year, all enrollees — even if they do not change insurance plans — will be entitled to a free annual checkup and free screenings, like colonoscopies and mammograms.

For people of all ages, many details of the new prevention benefits will remain sketchy until Health and Human Services writes the rules.

“Here, as with many other places in the legislation, much will depend on how H.H.S. writes the implementation regulations,” says Timothy S. Jost, a professor of law at Washington and Lee University School of Law and an expert on health reform.

Generally, though, here is how preventive services will be integrated into health insurance plans, beginning this fall.

NO OUT-OF-POCKET FEES New group and individual health plans must provide preventive health services at no additional charge to consumers — the services will not be subject to a co-payment or to a deductible.

BASED ON FEDERAL GUIDELINES The preventive services will include those that the United States Preventive Services Task Force, a panel of outside experts under the Health and Human Services Department, has given their top A or B rating, like screenings for H.I.V., depression, osteoporosis in postmenopausal women, as well as breast, colorectal and cervical cancer. Children will receive free screenings for conditions including iron deficiency, sickle cell diseases and hypothyroidism. A government Web site has a handy calculator that lets you enter a person’s age and gender to see what those screening recommendations would be. (We have also posted the task force’s entire list of recommendations with the online version of this column.)

In addition, immunizations recommended by the Centers for Disease Control and Prevention will be covered, including vaccines for Hepatitis A & B, tetanus-diphtheria, seasonal flu vaccines and human papilloma virus for girls 9 to 26 years old.

WHEN IT TAKES EFFECT The parts of the law governing preventive care go into effect on Sept. 23 (six months after it was signed by the president). At that point, new plans, and plans that make changes, must start to offer free preventive care. If you are covered by Medicare, the upgrades will go into effect on Jan. 1.

If these changes sound too far off, or you have resigned yourself to not seeing any benefit because you will not be changing insurance plans any time soon, take note: if you have group coverage, you may already be entitled to some free preventive benefits. Check what your plan offers, either by calling the toll-free customer service number on your membership card, looking at your insurer’s Web site, or reading the plan’s summary plan description booklet (free services are usually listed up front).

“Employees tend not to read their benefits information,” Ms. Darling said.

One of your best health habits should be to make good use of the services that will not cost you a cent.