Under the ACA, some 62 preventive services and products will be free: no copays and the deductible will not apply. The list includes vision checks for children, birth control, and more than a dozen vaccines.
This rule will hold true not just for plans sold in the exchanges, but for most employer-sponsored plans. Under Obamacare, they, too, must offer preventive care without cost-sharing – unless they are “grandfathered.” (Grandfathered plans are policies that existed before the ACA was passed in 2010, and that have not made substantial changes to benefits or cost-sharing since then.)
This year, just 36 percent of Americans who have health benefits at work are enrolled in a grandfathered plan,, down from 48 percent in 2012 and 56 percent in 2011. Each year, more plans will lose their grandfathered status.
The ACA’s list of preventive services and products covers most of the reasons that many of us visit a physician – for blood pressure checks, cholesterol checks, flu shots, mammograms, tetanus shots, Pap smears or colorectal cancer screening.
Some of us go to the doctor because we want help losing weight, or quitting smoking. Counseling and smoking cessation products – including nicotine patches – all make the list.
If we feel sad, and don’t know why, we may want to be screened for depression. Under Obamacare, this is a free preventive service. If you are a new mother who is feeling blue – or a 60-year-old man who just doesn’t want to get up in the morning – and your primary care physician (PCP) determines that you are depressed, he will send you to a someone who can provide counseling andor medication. The initial consultation with your PCP is free.
Preventive care for kids
As parents, we take our children to doctors for a host of reasons – often because we want advice. “What should I feed a plump six-year old?” “My 14-year-old doesn’ like to leave his room-and he is being teased at school. Should I be worried?”
The ACA lists 25 preventive services for children, including diet counseling, depression screening for adolescents, , oral health risk assessments for children under age 11, behavioral and developmental assessments, vaccines to protect against 12 diseases, obesity screening and counseling, flu shots and tetanus shots.
How Much Will You Save? Why Should Men Pay for Contraception?
Some men are not happy that part of their insurance premium will pay for contraception. “I’m single and I never plan to have children” one HealthBeat reader grouses. “Why should I pay for it?
There are many answers. But here is an easy one: Women use more preventive services when they are younger, but as men age, the fact that they didn’t go to the doctor for blood pressure screening – or help losing weight – catches up with them. According to the Health Cost Institute, healthcare spending for women exceeds spending for men until age 60. At that point men’s healthcare becomes more costly.
This is when healthy women begin subsidizing men. Of course, much depends on how long an individual lives. If a fit 70-year-old woman survives until she is 95, she may, in the end, cost society more than an overweight man who has a knee replacement, suffers from diabetes, and dies of heart disease at age 75.
But over the long run, these things even out. Different people need more care at different points in their lives. This is how insurance works: over time, we subsidize each other.
I originally wrote about preventive care on Healthinsurance.org. To find out more about how much you will save, and how free preventive care affects the maximum that you will ever be expected to lay out under Obamacare click here and scroll down to “Most Won’t Exceed Their Deductibles.”