A key component of the Affordable Care Act is that it requires medical providers to cover certain preventative care treatments 100 percent (at no cost to the patient). That means other than your monthly premium cost, you shouldn’t have to pay a co-pay or use part of your deductible to cover certain medical treatments.
Unfortunately, even if preventive benefits are covered by your insurer, you may end up with a bill anyway. Doctors sometimes bundle together several different services on one bill, triggering a co-pay or deductible charge for services that would otherwise be 100 percent covered. Insurance companies sometimes errantly deny a claim that should be covered as well.
It’s important to understand what services should be covered under your coverage and to double check every bill you receive from your doctor to be sure you’re not being charged erroneously. You may also see a charge if your doctor’s medical billing office uses the wrong billing codes. If you end up with an unexpected bill, request an itemized bill and an explanation of benefits. If you see fees for covered screenings, call your doctor to have them adjust the bill. You can also ask your insurer to adjust the claim for you.
Here’s a list of benefits you can expect to receive for free.
1. Cancer Screenings
- Breast cancer screening (mammogram)
- Cervical cancer screening (pap smear)
- HPV screening (pap smear)
- Skin cancer counseling
- Colorectal screenings (fecal occult blood testing, flexible sigmoidoscopy, colonoscopy)
- Lung cancer screening (tomography)
2. Treatment and Screenings for Chronic Conditions
- Screening for the following diseases: abdominal aortic aneurysm, diabetes (blood glucose), hypertension (blood pressure), hepatitis B, hepatitis C, latent TB infection, liquid disorders, osteoporosis
- Depression screening
- Low-dose aspirin (adults with cardiovascular or colorectal disease risk factors)
Many tests required for chronic conditions require a blood or urine sample. If your doctor is worried about your health, they may test for multiple diseases that may not be covered by your insurance. In that case, you might have to pay a fee for that lab work. Furthermore, chronic conditions may require types of treatments that are not 100% covered by your insurer.
3. Health Promotion Treatment
- Alcohol misuse
- Obesity screening and management
- Diet and activity counseling for cardiovascular disease prevention
- Falls prevention (adults 65+)
- Tobacco cessation
- Well-woman visits
- Intimate partner violence screening and counseling
Initial counseling and tobacco cessation pharmaceuticals are covered at 100%, but your doctor may recommend therapies and counseling not covered by insurance. Be sure to ask if counseling will be billed as a preventive benefit.
4. Common Immunizations
All immunizations recommend by the Advisory Committee for Immunization Practices (ACIP) must be covered as preventative benefits. This includes over 20 types of immunizations, including the annual flu shot.
If you aren’t sure whether an immunization will be covered by your insurance, ask your doctor before you agree to the immunization.
5. Sexual Health Treatment
- Screening tests for chlamydia, gonorrhea, syphilis, HIV infection
- STI counseling
- HIV counseling
- Contraceptive services
Insurers must cover the lowest cost version of 18 unique forms of birth control. Treatment for sexually transmitted diseases or infections is not covered as a preventive benefit.
Lab work for sexually transmitted diseases that are not listed above will cost extra. Request cost estimates for all tests and screenings even if they are part of your standard wellness visit.
6. Prenatal Treatment
- Anemia, bacteriuria, gestational diabetes, HIV, hepatitis B, syphilis screening
- Depression screening
- Folic acid supplements
- Preeclampsia preventive medicine
- Tobacco cessation behavioral cessation support
- Breastfeeding counseling, supplies, and support
Many services provided to women who are pregnant should be covered. However, obstetricians commonly ask for tests outside of those listed above. You should expect to pay lab fees for those tests. Most obstetricians can provide clients with a list of routine pregnancy tests and associated costs. In addition to lab fees, you should expect to pay for ultrasounds, labor and delivery fees, and facility fees during your pregnancy and birth experience.
The bottom line: You should absolutely take advantage of free health benefits provided to you.
Preventive coverage can help you catch and cure otherwise deadly diseases. Curing early-stage diseases often costs less than later-stage treatments, and early treatments may save your life. Recent studies show that preventive benefits may save 2 million lives and $4 billion dollars annually.
