Most everyone—even insurers—reacted positively to federal rules released last week requiring new health plans to cover many preventive services with no member cost-sharing.
Insurers, rest of industry applaud free screenings
Under the rules, screenings on blood pressure, cholesterol, diabetes and some cancers will be covered as well as immunizations; weight-loss and smoking-cessation counseling; well-baby checkups; and pregnancy care.
New health plans that begin on or after Sept. 23 must provide these services with no copayments, deductibles or other out-of-pocket costs to members. So-called “grandfathered” health plans—those plans already in effect and that don't drastically change benefits—are exempt. HHS estimates that, in 2011, about 31 million people will be enrolled in a group health plan subject to these prevention provisions. By 2013, HHS expects 73 million people to be enrolled.
“Getting access to early care and screenings will go a long way in preventing chronic illnesses like diabetes, heart disease and high-blood pressure,” said first lady Michelle Obama, at an event unveiling the rules on July 14.
Insurers approved of the interim final regulations on this prevention provision of the Patient Protection and Affordable Care Act, said Robert Zirkelbach, spokesman for America's Health Insurance Plans.
Specifically, the ban on member cost-sharing for preventive services doesn't apply to out-of-network providers. Also, members can still be charged a copayment or other costs for an office visit where a prevention screening takes place but is not the true intent of the visit.
In the regulations, HHS warned that absent these nuances, “this could create financial incentives for consumers to request preventative services at office visits that are intended for other purposes in order to avoid copayments and deductibles,” which would increase premiums.
HHS estimates that the new preventive services rules will raise premiums by 1.5% on average, according to the regulations.
The American Cancer Society praised the rules, saying that “removing financial barriers to preventative care will help transform our ‘sick care' system into one that focuses on disease prevention and management as well as improved wellness and quality of life.”
Americans use preventive services at only half the recommended rate, according to HHS.
Still to come are recommendations from an independent panel for women's services, expected on Aug. 1, 2011. Planned Parenthood is lobbying for prescription birth control and family planning to be classified as preventive services not subject to member cost-sharing.
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