Preventive Care

Preventive Care Benefits: Perpetually Changing


Who can keep track of all the changes being made to your health plan’s preventive care benefits? If you follow benefits within the Medicare program, you likely know that in 2008 the Medicare Improvements for Patients and Providers Act (MIPPA) authorized a free preventive care exam to be provided within 12 months of signing up for Medicare Part B, rather than the previous six months. MIPPA also added new elements to this preventive exam- including body mass index- and waived the deductible for it, starting in January 2009.

Now, in 2010, we have the Patient Protection and Affordable Care Act (PPACA) changing Medicare’s preventive care services yet again. First, cost sharing is eliminated for some preventive care services, including colorectal cancer screening, as an example. Second, instead of only receiving a deductible-waived preventive exam upon first obtaining Medicare Part B, all Medicare recipients can get a comprehensive wellness assessment every year with no co-pays or deductibles. (From the Author -- although Medicare is now covering more costs for preventive care than ever before, we advise caution when ordering medical tests and services as they may be subjected to Medicare Part B deductible and co-insurance requirements.)

Furthermore, the PPACA greatly increases preventive care services that must be covered by “non-grandfathered” health insurance plans as of September 23, 2010. Not only will health insurance companies have to provide for preventive care, but they will have to cover all costs associated with it. Preventive care benefits that must be covered include, but are not limited to immunizations, mammography tests, and tests for obesity. Also, preventive care and oral health are being promoted in public school systems as part of the PPACA. Use at your own risk!

Look for a post coming soon explaining “grandfathered” vs. “non-grandfathered” health insurance plans! Since the rules imposed by PPACA impact these plan types differently, you’ll want to know which type of plan covers you, and how your plan will be impacted by PPACA.