Hot Topics Blog
Tuesday, April 25 2023
If you have a health insurance plan that is not grandfathered under the Affordable Care Act (ACA), you may be enjoying some of its benefits without even realizing it. One of the most popular features of the ACA is that it requires most health plans to cover a set of preventive services at no cost to you. This means you don't have to pay a deductible, copayment or co-insurance when you get these services from a provider in your plan's network.
Preventive services include things like shots, screening tests, counseling and wellness visits that can help you stay healthy and detect or prevent serious medical conditions. For example, under the ACA, women can get free mammograms, cervical cancer screenings, contraception and prenatal care. Children can get free immunizations, developmental screenings and vision tests. Adults can get free blood pressure checks, cholesterol tests, diabetes screenings and tobacco cessation counseling.
These services are not only good for your health, but also for your wallet. According to a report by the U.S. Department of Health & Human Services (HHS), more than 150 million people with private insurance, including 58 million women and 37 million children, are receiving preventive services with no cost-sharing, as required by the ACA . The report estimates that these services have saved Americans $7.5 billion in out-of-pocket costs in 2019 alone.
However, these benefits are now at risk because of a recent court ruling that overturned some of the ACA's preventive service requirements. On January 6, 2022, a U.S. District Court judge in Texas ruled that some of the preventive services that health plans must cover with no cost-sharing are unconstitutional and violate the religious rights of some employers and individuals . The ruling affects services such as breast cancer genetic testing, contraception, sterilization and counseling for sexually transmitted infections.
The ruling is not final and is expected to be appealed by the Biden administration, which has vowed to defend the ACA and its preventive care benefits. However, in the meantime, some health plans may decide to stop covering these services with no cost-sharing or drop them altogether.
That's why Washington Insurance Commissioner Mike Kreidler has sent a letter to all health insurers in the state, urging them to continue providing coverage of all recommended preventive services without cost-sharing for patients. He said that millions of people rely on this benefit to get affordable coverage of early detection and prevention of serious medical conditions. He also said that his office is exploring all options including legislative solutions to protect this benefit for Washingtonians.
If you are one of the many people who benefit from the ACA's preventive care requirements, you should be aware of this court ruling and how it may affect your coverage. You should also contact your health plan and ask them if they will continue to cover these services with no cost-sharing or not. If they don't, you may want to shop around for a different plan that does during the next open enrollment period or see if you qualify for a special enrollment period due to a change in your coverage.
Preventive care is one of the best ways to protect your health and save money on health care costs. Don't let this court ruling take away your access to these valuable services.