News Alerts

An Ounce of Prevention is Worth a Pound of Cure?

Was this adage in the mind of the National Academy of Sciences Institute of Medicine when it submitted recommendations to Kathleen Sebelius to guarantee free preventive insurance services coverage for women as a part of Affordable Care Act?

An important component of health care reform is including preventive care as a health insurance benefit. Many procedures, like mammograms and colonoscopies, act as an early detector of a serious illness and could reduce devastating emotional and financial impact. Other procedures to be covered include screenings for gestational diabetes, cervical cancer and HIV. Eliminating copayments and deductibles for these screenings will hopefully motivate women to be more attentive to their overall health.

The list provided by the National Academy of Sciences included specific recommendations to issue new standards for providing preventive services for women. This mandate applies to private insurance plans beginning on or after Aug.1, 2012; for calendar year plans, Jan. 1, 2013. Certain plans may have been grandfathered when ACA was signed in March 2010. As employers modify their plans, fewer will retain their grandfathered status.

Although the administration believes the effect on premiums will be minimal, insurers think otherwise as the number of physician office visits will surely increase. The rules do, however, speak to medical management to assist insurers in controlling costs. Some include a drug benefit copayment where a brand name is chosen instead of a generic substitute.

One particularly controversial requirement set forth is the expanded coverage of contraception. As expected, there is significant opposition to birth control as a benefit, but health plans offered by certain religious employers would be exempt from these new regulations. Whether this exemption is appropriate remains to be seen.

An ounce of prevention is only worth a pound of cure if it’s known Studies have shown that Medicare participants use preventive services less than they should. Also, expanded coverage for preventive services only help those that are insured.

Individuals should watch their health insurance programs for these and other critical changes. For additional information, contact Ellen at EAB HealthWorks.