Are you taking advantage of everything your health insurance plan has to offer? For example, did you know that many preventive services are covered at 100 percent if you stay within your plan network? After the Affordable Care Act (ACA) was written into law in 2010, services deemed by the health insurance carriers as “preventive” were covered, including physicals, well-child visits, most vaccines, preventive screenings, etc. Additional services that are considered preventative include:
- Routine yearly blood work
- Alcohol misuse screening and counseling
- Domestic violence screening
- Depression screening
- Osteoporosis screening for women over 60, based on risk factors
- And more (for additional preventive services, visit Healthcare.gov for an exhaustive list).
Grandfathered plans are exceptions when it comes to offering preventive care services because those services are subject to cost sharing.
The goal of preventive care is to ensure good health and, ultimately, lower the cost of health care. According to the Centers for Disease Control and Prevention, the four leading causes of death are caused by potentially preventable chronic diseases, including heart disease, cancer, chronic lower respiratory disease, and stroke. Health insurers want you to take advantage of these services each year to prevent complications or more serious illnesses down the line that may become catastrophic and expensive to treat.
Be sure to consult your explanation of benefits (EOB) after you receive a preventive service. Your EOB provides an analysis of the service you received, the date of your visit, the provider that facilitated the visit, the type of exam, and a breakdown of the cost of services. Preventative services, if seen at an in-network provider, should be covered on your EOB at 100 percent. However, this only applies to services that are deemed “preventive” by the insurance carrier. If you go in for your yearly doctor visit and disclose to your doctor that your knee has been hurting and you are experiencing a lot of pain, they may code your appointment as something else and you may be billed for the visit. We advise that you closely examine your EOB for discrepancies and call your doctor with any questions you may have.
There may be many advantages to your health insurance plan of which you are unaware. Contact your ARC representative to find out how you can use your plan to your benefit.