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Preventive Services Under Affordable Care Act

Group health plans underspend on primary care and overspend on prescriptions and facility charges according to recent studies. Preventive services improve health and can identify undiagnosed conditions that may require treatment before the condition becomes complicated and costly. 
 
 

Preventive Services under ACA

 In Section 2713 of the Affordable Care Act private health plans must provide coverage for a range of preventive services and may not impose cost-sharing on patients who receive the services. There are four broad categories the private plans must cover for adults and children.

They include:

  1. Evidence- Based Screening and Counseling

             -Screening for depression, diabetes, cholesterol, obesity, various cancers, HIV, and sexually transmitted infections Counseling for drug and tobacco use, healthy eating

  1. Routine Immunizations

              -Immunizations including influenza, meningitis, tetanus, HPV, Hepatitis A and B, measles, mumps, rubella, and varicella

  1. Preventive Services for Children and Youth

                 -Well-known visits, all FDA approved contraceptives, screening and counseling for STI’s and HIV, breastfeeding  support and supplies and domestic volume screening

  1. Coverage Rules and Implementation Challenges

              May Charge Companies:

                     -If office visit and preventive service are billed separately

                     -If reason for visit is not preventive service

                     -If service is performed by an out of network provider when an in network provider is available to perform the service (But if there is no network provider available, patient cannot be charged)

                    -If a treatment is given as the result of a recommended preventive service, but is not the recommended  preventive service itself, cost sharing may be charged

 

Contact us to learn how Cambridge helps deliver onsite primary care at no cost. 

 

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Arthur Grutt