Know Your Plan, Know Your Options
JOURNAL: ISSUE 2 - 2013
Validated by numerous studies, today's concept of primary care as a system that promotes health, improves care, and reduces overall is widely accepted, and represents a significant shift in medicine from the days when a doctor was someone to see only when you were sick.
Accordingly, provisions of the Affordable Care Act (ACA) now cover certain preventive services at 100% with no cost sharing to individuals. As a result, many health plans are required to cover certain preventive care services at no cost to you. You may be eligible for free preventive screenings, like blood pressure and cholesterol tests, mammograms, colonoscopies, and more. This includes coverage for vaccines and new preventive services for women and children. While these rights do not apply to health plans created before March 23, 2010, which are known as "grandfathered plans", they do apply to a number of BAC funds, such as the Gold and Silver Plus Plans offered by the International Health Fund (IHF).
It is important to know whether your plan covers these services at 100%, as you should not be asked to pay a copayment for then. Many doctors' offices ask for a copayment in advance of your seeing a doctor, so you may have to remind the office personnel that you are eligible to receive these services at no cost.
It pays to know your plan's provisions. You should check your plan's materials or contact the benefits administrator to find out if your health plan is grandfathered. If it is not, you should not be charged for any preventive services covered under the ACA. In addition to reviewing your plan materials, learn more about what services are covered at 100% at www.healthcare.gov/what-are-my-preventive-care-benefits/.
A key to good health is seeing the right provider at the right setting for the right cost. Fragmented care provided by specialists and hospitals can often be streamlined in your primary care physician's office, so it is important to have a relationship with a primary care provider. Many services that are provided in more expensive settings can be provided by your primary care provider, often at no cost to you. Knowing what your options are will help you be a better steward of your most precious asset, your health.