Navigating the Patient Protection and Affordable Care Act Part VIII - Preventative Care Benefits

Department of Financial Services, Consumer eViews Volume 7 Number 31

July 30, 2010

Sean Shaw, Insurance Consumer Advocate

One of the major aims of the Patient Protection and Affordable Care Act (PPACA) is to reduce health costs by reducing the need for healthcare later in life. The PPACA aims to achieve this by providing consumers with benefits that will encourage them to become healthier earlier in life. In the prior installments of this series the Office of the Insurance Consumer Advocate provided consumers with information related to various benefits that will become available to them this year and in the future. In this edition of the summer series, the Office would like to focus on preventative healthcare benefits that will be available to consumers.

The U.S. Preventive Services Task Force (USPSTF) has unveiled a listing of various preventative care services that will be available to consumers at a reduced or no cost in an effort to combat chronic illnesses. Treatments for obesity, alcohol abuse and depression are among the services that will be available to consumers in September 2010.

Under these regulations, new health plans beginning on or after September 23, 2010 must cover preventive services that have "strong scientific evidence" of their health benefits. Various preventative care services will be provided at little to no cost depending on the patient’s age, sex or if they are at a higher risk. The following are some of the new services that will be available to consumers:

• New insurance plans will be prohibited from charging consumers a co-pay or deductible for preventive medical services that have been indentified with the top recommendation from the USPSTF. These plans will be required to cover immunizations recommended for children and adults by an advisory committee of the Centers for Disease Control and Prevention.

Depending on your age and health plan type, you may have easier access to such services as:

• Blood pressure, diabetes and cholesterol tests.
• Many cancer screenings.
• Counseling from your health care provider on such topics as quitting smoking, losing weight, eating better, treating depression and reducing alcohol use.
• Routine vaccines for diseases such as measles, polio or meningitis.
• Flu and pneumonia shots.
• Counseling, screening and vaccines for healthy pregnancies.
• Regular well-baby and well-child visits from birth to age 21.

Consumers should note that not everyone will be eligible for all services. Only people in insurance plans beginning after September 23rd, 2010 or in existing plans that change substantially will be able to get the discounted preventive services. For more information regarding preventative care services, consumers should visit http://www.healthcare.gov/.

As more information is available and additional changes become effective, the Office of the Insurance Consumer Advocate will generate advisories regarding preventative care services for consumers. More information regarding the PPACA can be found on the Insurance Consumer Advocate’s website at, http://www.myfloridacfo.com/ica/federalhealthcare.asp.