Some preventive care will have no copays under new benefits
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.