Yet another article on making sure your “free” health screenings under Obamacare are actually free. When something is as convoluted and bureaucratic as the Affordable Care Act (ACA) there are bound to be problems.
Since late 2010, when this provision of the ACA took effect, many patients have paid nothing when they undergo routine mammograms, get one of more than a dozen vaccines, receive birth control, or are screened for other conditions, including diabetes, colon cancer, depression, and sexually transmitted diseases.
That can translate to big savings, especially when many of these tests can cost thousands of dollars.
The following are five tips to make sure your preventive screenings are actually free:
- Your insurance matters.
- It’s always advisable to check with your health plan to see what is covered. Plans regulated under the ACA have specific items that are covered that plans not regulated by the ACA may not cover. When in doubt, check with your plan.
- Not all preventive services are covered.
- The federal government currently lists 22 broad categories of coverage for adults, an additional 27 specifically for women, and 29 for children. If a service is not recommended by the U.S. Preventive Services Task Force or codified within the ACA, it’s probably not covered. What is covered often varies by age, for instance.
- There can be limits.
- Read the fine print. You can’t have two colonoscopies in one year or one before age 45. Smoking cessation is limited to two attempts per year, for example. Insurers tried unsuccessfully to only allow one free STD test a year. California informed them that wasn’t enough under either federal or state laws. That raises another question: wouldn’t you be likely to only seek an STD test if you suspect you may have an STD? That could change whether or not it’s covered by your health plan.
- Some tests — often the expensive ones — have special challenges that affect coverage determinations.
- This a big one. Colonoscopies are considered diagnostic (rather than preventative) if you actually have a reason to suspect something, like blood in your stool. This is likely true of other tests where you have reason to suspect, say getting a mammogram for a lump in your breast. Why does this matter? Because a diagnostic procedure may pay your physician better than a screening one. The former certainly costs the patient more than the latter. I’ve heard of people trying to get their once-a-year wellness screening under Obamacare and discovering any questions by either the doctor or patient can render it an office visit with cost sharing. You have to specifically say you want your annual wellness visit and need to keep it at that. A request for a refill would likely render it an office visit (that pays your doctor better) rather than the worthless wellness visit.
- I recently wrote about an example where a man and wife both got colonoscopies weeks apart. His was considered a health screening and cost him nothing, while hers required $2,185 in cost-sharing because her colonoscopy found a polyp whereas his did not. For a time health insurers tried to claim any colonoscopy that found a polyp was diagnostic rather than preventative. That has changed but there is still some room for differing interpretations.
- Vaccines and medicines can be tricky, too.
- This again is a time to check with your health plan. Some vaccines are covered while others may not be for certain populations. Some medications are preventative while others are not. Health plans can opt out of birth control, for example under certain conditions.