Understanding the preventive benefits available from the health care law.
Cara James, Ph.D. is the Director of the Office of Minority Health at the Centers for Medicare & Medicaid Services. She’s been featured on radio shows across the country and speaks to various groups about the importance of understanding the preventive benefits available from the health care law. Dr. James took a moment to provide Heart & Soul readers with answers to some of the questions she’s most commonly asked.
Why is there a strong focus on prevention?
Today, too many Americans don’t get the preventive health care they need to stay healthy or to avoid or delay the onset of disease. Lastly with the health care law, preventive care is more affordable and allows Americans to detect disease in the early stages when it is most treatable. Chronic diseases, such as heart disease, cancer, and diabetes are often preventable with early detection.
What is the importance of prevention for African Americans?
Expanding access to preventive care can improve health outcomes for 41 million African Americans by helping to prevent many diseases that have a major impact in this community. African Americans are more likely to die from heart disease and cancer than any other racial or ethnic group. They also suffer at high rates from other life threatening conditions like obesity, asthma, stroke, and HIV/AIDS – conditions that can often be prevented. The health care law enables more people to access life-saving screenings and treatment.
What are some of the specific benefits available, particularly for women?
The new regulations ensure that health plans cover a variety of cancer prevention tools for women, including mammograms, and other relevant services to prevent breast cancer; Pap smears to screen for cervical cancer, and coverage for the HPV vaccine. There are also regulations to make sure that mothers have access to services they need to ensure a healthy pregnancy, such as, screening for conditions that can harm pregnant women or their babies, and special pregnancy-tailored counseling from a doctor that will help pregnant women quit smoking and avoid alcohol abuse. In addition, counseling is available to help and support nursing mothers who are breast-feeding.
Are there benefits available for children?
There is a comprehensive set of preventive services available for children. These include well-baby and well-child visits, which cover a host of preventive health services and screenings, as well as counseling to prevent, detect and treat common childhood problems like obesity. Other benefits include screening for depression among adolescents, vision and dental screenings, and immunizations. Most importantly, if an insurance plan covers children, parents can add or keep their children on their policies until their 26th birthday. Before the changes to the health care law, insurance companies could remove enrolled children usually at age 19, sometimes older for full-time students.
What about benefits for those over 55?
With the health care law, people with Medicare now have a number of no-cost preventive benefits including annual wellness visits, well woman visits, immunizations, and screenings to detect life-threatening conditions and illness – like cancer and heart disease – in the early stages, when they are most treatable. There is also a 50 percent discount on prescription drugs for people with Medicare in the coverage gap known as the “donut hole.”
How much will these prevention benefits cost?
The law has eliminated cost sharing. This means that health plans are now required to cover recommended preventive services without charging a deductible, co-pay, or coinsurance. In most cases, there are no out-of-pockets expenses for preventive care services.
Does preventive care provide savings? And if so, who is most impacted?
While the elimination of co-pays, deductibles, and other cost sharing under the health care law will mean cost savings for all Americans, it will provide significant savings for Americans in greatest need of important, potentially life-saving preventive services. For instance, if a 58-year-old who is at risk for disease receives a mammogram, a colon cancer screening, a Pap test, a diabetes test, a cholesterol test, and an annual flu shot, combined these screenings could cost more than $300 out of pocket under a typical insurance plan. The good news is that all these preventive screenings and tests would be covered under the health care law.
Where can I go to learn more?
Simply visit www.healthcare.gov/prevention