Preventive care is critical for illness and disease prevention. However, for many years, preventive care has not been as accessible and underutilized. The Centers for Disease Control (CDC) suggests that this results from an implementation gap, not a lack of information. Providers have not prioritized prevention because treatment is often the main focus.
The Affordable Care Act (ACA) recently changed preventive care policies to increase access and utilization. However, navigating these changes can be challenging. So, our experts at My Healthcare Direct will provide all the information you need. We have outlined updates surrounding preventive care in health insurance policies. Then, you can make the best decisions for your health.
What is Preventive Healthcare?
Preventive healthcare promotes patient wellness using disease, illness, and injury prevention tools. It typically includes health screenings, immunizations, and checkups.
How Does Preventive Healthcare Work with Insurance Policies?
Most healthcare services must cover preventive healthcare services at no cost. This includes plans through the Health Insurance Marketplace. However, insurers only provide these services if members use in-network providers.
Preventive care services consist of:
- Immunizations
Insurers cover routine immunizations for influenza, hepatitis, rubella, and more.
- Screenings
Screening is for mental and physical health issues like depression, diabetes, and obesity.
- Counseling
There is counseling for tobacco and drug use and healthy eating. This also includes other common health concerns.
- Medications
Insurers cover medications that can help prevent HIV, breast cancer, and heart disease.
- Colonoscopies
ACA requires that insurers don’t charge a copay for colonoscopies.
In 2010, the ACA made coverage more comprehensive for over 100 preventative services. Over the years, ACA made some policy changes. Specifically, in 2024, the ACA added section 2713 to the Public Health Service Act (PHS Act). It requires non-grandfathered group plans or individual health insurance to cover recommended preventive services. They cannot impose cost-sharing requirements, such as copayments, coinsurance, or deductibles.
These preventive services amendments include no cost-sharing for the following categories:
- Evidence-based screenings and counseling
- Immunizations
- Preventive screenings for infants, children, and adolescents
- Preventive screenings for women
New Rules Proposed
The ACA has also proposed new rules but has yet to implement them. These amendments aim to further reduce barriers to coverage, particularly for over-the-counter (OTC) contraception. So, plans and insurers must cover OTC without a prescription and cost-sharing. Furthermore, most private health plans must disclose that they cover OTC contraception. They must also disclose that they cover contraception without cost-sharing and a prescription.
Along with disclosures, there would be an exception process. Plans and issuers must provide a transparent exception process for recommended preventive services. They would be for individuals who need a product equal to the one prescribed if the physician considers it medically necessary.
If these rules were to be passed, the health insurance industry would make more progress in preventing mental and physical health issues.
Consult My Healthcare Direct for More Information on Preventive Care!
Do you need help with preventive care in health insurance policies? If so, consult My Healthcare Direct. We have extensive knowledge of insurance policies, products, and guidelines. Whether you are shopping for insurance or need help with switching plans, we will guide you every step of the way! Our specialists do what’s best for every client, servicing their needs proactively.
Contact us today to speak with an insurance agent! Let us know how we can help you.