By Maren Dunn, D.O. ExploreBigSky.com Health Writer
Is it true that preventive services like wellness exams, vaccines and birth control are now covered by my insurance plan?
– Nancy, Big Sky
The Affordable Care Act, aka “Obamacare,” has caused quite a stir in the health insurance marketplace. While it is a complex piece of legislation, many parts of the law have already gone into effect, producing multiple benefits for consumers.
Since 2011, preventive care for insured patients has been free. Deductibles and co-pays don’t apply to yearly wellness exams, most vaccines, or screening for things such as high cholesterol, diabetes and sexually transmitted infections. Cancer screenings through colonoscopies, mammograms and pap smears are also covered.
As of August 2012, ACA requires new or renewed insurance plans to cover the cost of birth control and sterilization procedures. For women, this includes oral contraceptive pills and intrauterine devices, among others. Breast-feeding support and supplies and routine pregnancy blood testing are covered at no additional cost. This means you will not be charged a co-pay at the pharmacy or in the office.
Insured people are also covered at no cost for screening and counseling services relating to alcohol abuse, depression, weight loss and domestic violence. Screening and treatment for tobacco use also falls into the preventive services category.
The ACA mandates accountability from insurance companies in order to protect you, the consumer. One example is the 80/20 rule: 80 cents of each premium dollar must be spent on your healthcare or improvements to care. If insurance companies fail to meet this standard, they must provide rebates to their customers. Over $1 billion has already been distributed back to consumers.
Additionally, if an insurance company wants to raise its premium rates by 10 percent or more, it must publically justify the increase while exposing this information. All 50 states have been given the power to review and block rate hikes.
If you’ve been denied insurance coverage due to pre-existing conditions, you’ve encountered a frustration that’s receiving attention. Under the ACA, state and federal insurance plans have been developed called Pre-existing Condition Insurance Plans. To qualify for a PCIP, you must be a U.S. citizen or legal immigrant, have been uninsured for at least six months, and either have a pre-existing condition or been denied coverage because of health problems.
Furthermore, the law states that children cannot be denied private insurance coverage due to pre-existing conditions. And if you’re 26 years old or younger, you can stay on your parents’ insurance plan. So far, this measure alone has allowed more than 3 million young adults to retain health insurance.
In the past, many people suffered financial consequences from hitting their insurance limits, or had their coverage dropped mid-illness. In response, the ACA outlawed lifetime cost limits. As of January 2014, yearly coverage limits will also be banned. Moreover, insurance companies cannot take away your coverage when you get sick.
The ACA also made many other changes to the healthcare industry. To find out more, visit healthcare.gov or call your insurance company. Be sure you and your family are taking full advantage of all benefits available to you.
To contact the state of Montana’s PCIP program, call (800) 447-7828 x2128 or visit mthealth.org/
By the numbers
12,000 – number of Montanans under age 26 who gained insurance since 2011
166,000 – number of Montanans who gained free preventive services in 2011
140,400 – number of women in Montana who can now obtain free contraception and other women’s health services
$194 – average rebate Montana families with private insurance can expect from the 80/20 rule this year
345 – number of Montanans with pre-existing conditions now insured under the state’s PCIP
resource – healthcare.gov