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Great news! Health and Human Services Secretary Kathleen Sebelius announced last week that the Affordable Care Act has provided approximately 54 million Americans with at least one new free preventive service in 2011 through their private health insurance plans.

This Wellness Wednesday, we’re breaking down the covered preventive service provisions in the ACA and taking a closer look at what this could mean for you.

What does free mean, really?

If you’re eligible for these free preventive services, that means that you do not have to pay:

  • A co-payment
  • Co-insurance
  • A deductible

This provision only applies to in-network providers. If you use an out of network provider, you will have to pay for these services. Always double check with your insurance company that a provider is in-network, especially if you’re visiting a new doctor.

For in-network doctors, though the preventive service will be free, you may still have to pay an office visit fee if:

  • The preventive service is not the primary purpose of the visit.
  • Your doctor bills you for the preventive services separately from the office visit.

Check with your doctor’s office before your appointment to find out how they structure their billing and if you will be expected to pay a fee for your visit.

Are you eligible?

The preventive services provision only applies to people enrolled in “non-grandfathered” plans, aka job-related health plans or individual health insurance policies created after March 23, 2010.

Not sure if your plan is grandfathered? Here's what you can do:

  • Check your plan materials: According to Healthcare.gov,  "health plans must disclose their grandfathered status in plan materials distributed to subscribers."
  • Talk to your employer or your health plan’s benefits administrator: Healthcare.gov says "If you are in a group health plan, the date you joined may not reflect the date the plan was created." Check with your employer or benefits administrator about the status of your plan.

What preventive services are covered?

Here's a list of covered preventive services for kids, women, and men, from the new Assistant Secretary for Planning and Evaluation (ASPE) Issue Brief "Fifty Four Million Additional Americans Are Receiving Preventive Services Coverage Without Cost-Sharing Under the ACA."

Kids (under 18): 

  • Regular pediatrician visits
  • Vision and hearing screening
  • Developmental assessments
  • Immunizations (Learn more about immunizations under the ACA)
  • Screening and counseling to address obesity and help children maintain a healthy weight.

Click here for the full list of covered preventive services for children.

Women (18 to 64): 

  • Pap smears for those ages 21 to 64
  • Mammograms for those ages 50 to 64
  • Colonoscopy for those 50 to 64
  • Recommended immunizations such as HPV vaccination for women ages 19 to 26
  • Flu shots
  • Meningococcal and pneumococcal vaccinations for high-risk adults
  • Healthy diet counseling and obesity screening;
  • Cholesterol and blood pressure screening
  • Screening for sexually-transmitted infections and HIV
  • Depression screening
  • Tobacco-use counseling.

Click here for the full list of services, including preventive services specifically for pregnant women. Many women's preventive services will start in August 2012, such as contraception and gestational diabetes screening.

Men (18 to 64): 

  • Flu shots
  • Meningococcal and pneumococcal vaccinations for high-risk adults
  • Colonoscopy for adults 50 to 64;
  • Healthy diet counseling and obesity screening
  • Cholesterol and blood pressure screening
  • Screening for HIV
  • Depression screening
  • Tobacco-use counseling.

Click here for the full list of covered preventive services for adults.

Have you or your family benefited from this new provision?

That's great! We want to hear all about it. Click here to share your story today.


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