One welcome provision of healthcare reform embraces the adage that an ounce of prevention is worth a pound of cure. As of September 2010, new insurance plans (and some established ones) are offering participants a host of preventive health services at no additional cost, from cancer screenings and AIDS tests to counseling on diet and sexually transmitted diseases.
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Previously, the rules about preventive coverage varied significantly by state and type of service, and they often required the policyholder to share the costs in the form of a copayment or a fee counted toward a deductible. While there are still limitations on who can get which services and how often (for example, only women ages 40 to 74 can receive free mammograms every other year), the law makes more accessible several dozen types of care that experts agree could save lives. "Preventive stuff gets kind of pushed to the side," says Jud Richland, president and CEO of Partnership for Prevention, a Washington, D.C.-based health research and advocacy group. "The hope is that by fully covering these things, over time delivery of these services becomes more top of mind."
The new law immediately affected plans created after March 23, 2010; insurers had to amend policies by September 23. Older plans have to include the required preventive services only when the administrator makes any other changes to existing coverage. Some employers have already taken the initiative to provide many of these services at no extra charge to their workers, and Medicare recipients also now can get a number of tests and vaccines at no additional cost. Consumers should note, though, that if their health plan mandates using a specific set of providers, then their costs are picked up entirely only when they visit a designated in-network facility or caregiver.
The current list of covered services is based on recommendations from the Centers for Disease Control and Prevention, the Health Resources and Services Administration, and the U.S. Preventive Services Task Force, an independent national panel of more than a dozen primary care and prevention experts. The task force evaluates medical research and assigns ratings to particular services based on their predicted benefits and potential risks for the patient. The list includes recommendations that infants, children, and adults be provided with the full schedules of CDC-endorsed immunizations, as well as services (such as blood pressure tests or certain cancer screenings) that receive an "A" or "B" task force rating, indicating that they will likely provide "substantial" to "moderate" benefits to the individuals being treated. Insurers are required to check the task force list annually and to include all "A" and "B" rated services in their coverage.
To find out which ones apply to you, check out the Department of Health and Human Services' Electronic Preventive Services Selector, which is available online or as a smartphone application. The selector retrieves a personalized list of task force-endorsed services based on your answers to five questions about your age and sex, and whether you smoke, are sexually active, or are pregnant. The list might go well beyond the typical fare of a standard physical. Adults who are concerned about possible alcohol abuse, obesity, or tobacco addiction, for instance, can seek free counseling.
One goal of the task force list is to steer consumers toward medical services of established value and away from tests and treatments whose effectiveness is unproven. "Where we lose is when people go out there and get things that are not recommended," says Virginia Moyer, chair of the task force and a professor of pediatrics at Baylor College of Medicine in Houston. Tests such as dementia screening and chest X-rays for lung cancer (for nonsmokers and asymptomatic smokers) that haven't yet shown substantial benefits sap medical resources, she says, and could even expose people to greater health risks such as excess radiation from certain imaging devices. And a false diagnosis could lead to more costly—and unnecessary—procedures or treatments.