What services are considered “preventive care”?

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21575265_MOne of the biggest accomplishments of the Affordable Care Act was mandating that preventive care services should be free-of-charge for consumers. There are numerous benefits of free preventive care: for individuals, this includes lower personal healthcare costs and earlier diagnoses for potentially life-threatening diseases; for society, this has led to decreased overcrowding in emergency rooms and improved levels of public health.

Although a law mandating zero-copay preventive care may seem to increase national healthcare spending (the mandate also applied to Medicaid and Medicare programs, after all), it actually does the exact opposite by nipping problems in the bud before they develop into full-blown health crises (e.g., massive flu epidemics are mitigated by free flu vaccines and someone with cancer has a much higher chance of survival if the cancer is detected earlier on).

If you’ve wondered what preventive care services are covered and how much they cost without insurance or ACA $0-copay mandates, continue reading to learn more:

Vaccinations

According to the Centers for Disease Control, routine vaccinations and other shots cost anywhere between $25 to $200 or more, on average. However, when you have insurance, immunization shots are considered preventive care, which means you can get the flu vaccine, tetanus shot, HPV vaccine and other shots free-of-charge. Vaccinations are scientifically proven to be beneficial when it comes to preventing outbreaks of serious and highly infectious diseases like the flu, polio, measles and STDs, so it makes sense why these fall under the umbrella of “preventive care.”

For Children

There are many different pediatric services covered by the preventive care mandate, including: autism screenings (18-24 month-olds), behavioral assessments (including mental health screenings from ages 12+), blood pressure screenings, immunization vaccines, vision and hearing screenings, and much more.

Of course, it should be noted that these services are provided free-of-charge to those covered by PPO health insurance when they use in-network providers, so don’t risk having to foot the bill by going out-of-network.

For Women

When it comes to $0-copay preventive services offered to women, there are quite a few services you might not realize are fully covered by insurance. Some of these services include: annual well-woman exams, mammograms, anemia screenings, STD screenings, breastfeeding counseling, and postpartum mental health screenings, to name a few. In many states, contraception is also covered free-of-charge.

In a world without $0-copay preventive services, women could pay a lot more for healthcare, such as $267 for a mammogram or $1,100 for a Mirena IUD.

Screenings for Adults

For all adults, screenings for a variety of cancers is the most common $0-copay benefit, though other covered preventive care services may include: alcohol counseling, blood pressure screenings, and obesity screening and counseling. Even if you think you’ll never need some or any of the services mentioned above, it’s still incredibly useful to have health insurance to guard against potential health risks without having to pay for these otherwise costly services out of pocket.

Pros and cons of PPO health insurance plans

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46515613 - group of medical doctors over hospital background. health care.Whether this is your first time shopping for your own health insurance or you’ve been with an HMO company for most of your life and you’re considering a switch, don’t jump into a PPO insurance plan before evaluating these pros and cons to see if it’s right for you and your health care needs:

Pro: Flexible Network of Providers

One of the biggest advantages of a PPO plan is that you have access to substantially more medical providers than you would with an HMO plan. You can switch doctors and facilities if you’re unhappy with your current ones, and you can easily find out who accepts your insurance by searching different services and doctors in your area through a PPO’s online search portal.

Con: Cost Confusion

HMO plans are relatively streamlined, while PPO plans aren’t as simple. First, you have to figure out the difference between in-network and out-of-network providers (and these providers may eventually change their status with your PPO insurance company). There are typically low co-pays charged for services rendered by in-network providers, while out-of-network providers may require co-insurance payments (percentage of the cost of services received).

There are also deductibles to think about with a PPO insurance plan (while many HMO plans have no annual deductible). HMO plans are generally cheaper in terms of monthly premiums, but you’re 100% responsible for costs incurred at out-of-network provider facilities, so the higher monthly cost for a PPO plan might be worth it just for the flexibility.

Pro: More Service Availability

A PPO insurance plan allows you to access a vast range of services, including preventative care, mental health services, prescriptions, specialist treatments, surgeries, fertility treatments and maternal care, physical check-ups, and much more. Depending on the available HMO plans in your area, a PPO may offer significantly more services than your typical HMO (especially since you’re not limited to one medical provider and get access to a fuller network of providers in your area).

Con: Unclear Rules and Restrictions

When you have a PPO insurance plan, there’s a small chance you might run into some issues with finding an in-network provider and figuring out claims and billing procedures for out-of-network doctor care or hospitalizations. For instance, some medical facilities’ websites say they accept a wide variety of insurance plans, but that doesn’t always mean they accept your specific plan or one of the doctors at the facility is a participating provider in your PPO network.

This can lead to some costly mistakes if you don’t directly ask them about their partnership with your PPO company before seeking treatment there. Furthermore, there may be a different company responsible for different services (for instance, some PPO companies have separate administrators for mental/behavioral health services), so as with any type of plan, it’s always a good idea to check with your insurance company well in advance of your appointment or procedure.