Preventative Care and the ACA

Preventative Care and the ACA

Most people are aware by now that the ACA requires all non-grandfathered plans to cover in-network preventative services (with no cost sharing on the participants part).  The list of covered services is determined by several government agencies – the U.S. Preventative Services Task Force (USPSTF), AICP, HRSA and IOM.

The thinking is that preventative care helps catch conditions earlier, and by removing cost barriers,  more people would take advantage of preventative visits. The goal is better overall health and lower costs.

However, like just about everything in healthcare, there are certain conditions.

  • The visit must be preventative. If, for example, you bring up your sore knee during the visit the doctor could call that an office visit and charge you for that.
  • The visit must be in-network.
  • The list isn’t open-ended, and not everything is covered. For example: A doctor will typically order several tests for the preventative visit, and maybe include a couple extras.  Lately, more people seem to be getting bills for tests performed that are not on the ‘approved’ (no cost sharing) list even though the doctor ordered them as part of the preventative visit.  If you get a bill from the lab after insurance has paid that may be the culprit.

Thanks and if you have any questions please feel free to contact us.

For more information here are a couple links:

Kaiser Family Foundation

Healthcare.gov Preventative Care

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