Some pre­ven­tive care will have no co­pays un­der new ben­e­fits

Austin American-Statesman - - WORLD & NATION - By Ri­cardo Alonso-Zaldivar

WASHINGTON — From coun­sel­ing for chil­dren who strug­gle with their weight to can­cer screen­ings for their par­ents, pre­ven­tive health care will soon be avail­able at no outof-pocket cost un­der con­sumer rules the Obama ad­min­is­tra­tion un­veiled Wed­nes­day.

That means no co­pays, de­ductibles or coin­sur­ance for peo­ple whose health in­surance plans are cov­ered by the new re­quire­ments.

The Obama ad­min­is­tra­tion es­ti­mates that 41 mil­lion Amer­i­cans will ben­e­fit ini­tially, with the num­ber pro­jected to rise to 88 mil­lion by 2013. Many large com­pany plans, which usu­ally of­fer solid pre­ven­tive ben­e­fits, will be ex­empt from the re­quire­ments for now.

Bet­ter pre­ven­tive cov­er­age is one of the goals of Pres­i­dent Barack Obama’s health care over­haul law, part of a shift to try to catch prob­lems early, be­fore high choles­terol can lead to heart dis­ease, for in­stance.

“Ser­vices like these will go a long way in pre­vent­ing chronic ill­nesses that con­sume over 75 per­cent of the health care spend­ing in this coun­try,” said first lady Michelle Obama, an­nounc­ing the new ben­e­fits at a Washington hos­pi­tal.

Bet­ter pre­ven­tive care may be an in­vest­ment, but it still car­ries an up­front cost. Premi­ums will go up by 1.5 per­cent on av­er­age, as spend­ing for the ser­vices is spread across an en­tire pool of in­sured peo­ple.

For in­di­vid­u­als who are dili- gent about their check­ups, that can mean con­sid­er­able out-of­pocket sav­ings. For ex­am­ple, a 58-year-old woman at risk of heart dis­ease could save at least $300 out of her bud­get on rec­om­mended tests, in­clud­ing mam­mo­grams, flu shots, and di­a­betes and choles­terol screen­ing.

Re­search has shown that peo­ple tend to skip rec­om­mended pre­ven­tive care if cost is an is­sue, and even a mod­est co­pay­ment can make a dif­fer­ence. Cost-free pre­ven­tion was one idea that re­ceived wide­spread sup­port dur­ing the con­tentious health care de­bate last year in Congress.

The pre­ven­tion re­quire­ments take ef­fect for health plans re­new­ing on or af­ter Sept. 23, which means most ben­e­fi­cia­ries will see them start­ing Jan. 1. Coin­ci­den­tally, that’s also when Medi­care re­cip­i­ents get ac­cess to most pre- ven­tive ser­vices at no out-of­pocket cost — an­other change un­der the health care law.

Un­der the re­quire­ments an­nounced Wed­nes­day, health in­surance plans have to cover four sets of pre­ven­tive ser­vices at no ad­di­tional charge to their mem­bers, in­clud­ing:

Strongly rec­om­mended screen­ings, in­clud­ing breast and colon can­cer tests, tests for di­a­betes, high choles­terol and high blood pres­sure, and coun­sel­ing to help smok­ers quit. Rou­tine vac­cines. Well-baby vis­its, vi­sion and hear­ing tests for chil­dren, and coun­sel­ing to help young­sters main­tain a healthy weight.

Women’s health screen­ings.

Large em­ployer plans will not be af­fected by the new re­quire­ments if they are “grand­fa­thered” un­der the health over­haul law.

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