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Consider These Affordable Options – Please!

We went over some of the benefits of the Affordable Care Act the other day, including its determined assault on insurance-speak and convoluted paperwork and forms, without mentioning another one of its pluses: broadening the access to preventive care and services.

Under the Act, many individuals and families may finally be eligible for some preventive services that really can make a difference. Under the new requirements, services that help avoid or minimize illness and generally improve health are available at no additional cost to the insured.  You know the theory: prevention beats cure every time.

A plan subject to the Act’s requirements means that covered individuals may not have to pay a deductible, co-insurance or a co-pay to get recommended preventive health services, including screenings, counseling and vaccinations.

This means (depending on your age) access to such services as:

  • Many cancer screenings, including mammograms and colonoscopies.
  • Blood pressure, diabetes and cholesterol tests.
  • Routine vaccinations against diseases such as measles, meningitis and polio.
  • Flu and pneumonia shots.
  • Counseling on quitting smoking, losing weight, eating more healthfully, treating depression, reducing alcohol consumption and other similar issues.
  • Counseling, screening and vaccines to ensure safe, healthy pregnancies.
  • Well-baby care and well-child visits, from birth to age 21.
How does all this work?
Here are some important details about the how’s and who’s of these provisions:
  • The preventive services provision applies to individuals enrolled in job-related health plans or individual health insurance plans created after 23 March 2010.  If this is you, this provision affects or affected you as soon as your plan begins or began its first new plan year or policy year (effective date) on or after 23 September 2010.
  • If your plan has been ‘grandfathered’, these benefits may not be available to you.  Check with your agent or plan administrator.
  • If your plan uses a provider network, keep in mind that the health plans are only required to provide preventive services through an in-network provider.  You may well be allowed to use the services of an out-of-network provider, but they might charge a fee for this. 
  • A preventive service, such as a cholesterol screening test, may be offered by your physician during an office visit.  Be aware that your health plan can ask you to pay some of the costs of the office visit if the preventive service was not the primary purpose of the visit or if your physician invoices you for preventive services separately from office visits.
  • To know which covered preventive services are right for you – and there are some you really don’t need – ask your health care provider or doctor.  The decisions are based on your age, health status and gender.  
  • Check with your insurer, agent or plan administrator with any questions you might have about how these provisions apply to your particular plan.  This is new territory for everybody, so your questions are perfectly valid and important.  Ask!
Tomorrow, we will list the specific services covered under the Act, for adults in general, women specifically and children.
It is calculated that Americans use preventive services at some half the recommended rate.  Again, that’s half the recommended rate.  The chronic diseases that account for 7 of 10 deaths among Americans each year – and account for 75% of the nation’s spending on health care – are, far more often than not, preventable.  These diseases include heart disease, cancer and diabetes, among others.
Something is wrong with the math here.  We may agree, or not, with health care reform measures; we may agree, or not, with lots of things.  But we have got to take responsibility for our own health and fitness, and that of our children and loved ones.  Freedom is not about doing whatever we please, eating whatever we please, drinking and smoking whatever we please.  That’s self-indulgence, not freedom.  Rather, freedom is about being free from dependence and addiction, free from pain and anger, free from chronic illness.  With good health, we are truly free to enjoy life’s many, many blessings.
So let’s be grown up about this.  Again, prevention beats cure every single time.
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