Taking the Co-Pay Out of Staying Healthy

More than 100,000 lives could be saved annually by increasing the use of just five preventive medical services -- aspirin to prevent heart disease, smoking cessation assistance, screenings for breast and colorectal cancers, and flu shots -- according to a 2007 study by the Partnership for Prevention. Yet a 2003 New England Journal of Medicine report said Americans get only half the preventive services recommended by their physicians.

The Patient Protection and Affordable Care Act is attempting to eliminate cost as a barrier to getting these services. Insurance providers will no longer be able to charge a co-pay, deductible or co-insurance for preventive services.

The rule currently applies to those covered by Medicare and Medicaid, and group or individual health plans established since Sept. 23, 2010. Private plans created before then will have to comply if they make "significant" changes that reduce benefits or increase costs -- such as major adjustments in co-pays, provider networks or drug benefits. "This tries to rebalance a system that has been largely focused on acute care instead of being healthy," said Dr. Roland Goertz, president of the American Academy of Family Physicians.

Patients may still have to pay for preventive services if they visit doctors outside their networks, bundle covered and uncovered services within the same visit, or go against the guidelines concerning the frequency, method or setting for receiving preventive services. However, the US Department of Health and Human Services estimates that 88 million Americans will have access to free preventive services by 2013.

A comprehensive list of recommendations -- which pertain to topics including diabetes, cholesterol, hepatitis, HIV, cervical screenings, mammograms, and genetic screenings for newborns -- is available at www.uspreventiveservicestaskforce.org/uspstf/uspsabrecs.htm.

Back to other news for January 2011