Health Care Reform
Even though summer is winding down, you probably have plans to be outdoors and enjoy the warm weather while you can. With a few weeks of sunshine ahead, we at Blue Cross Blue Shield of Michigan have not only been thinking about skin care and sun safety, but also about preparing Michigan for health reform.
The Affordable Care Act (ACA) focuses on helping consumers be more proactive about staying healthy through preventative care. In fact, provisions under the ACA require insurers to provide consumers with full coverage for many preventive services.
After a summer of fun in the sun, you probably want to know, are skin cancer screenings fully covered? The answer is no, the ACA does not require insurers to cover the cost of skin cancer screenings.
But don’t fear. There are still many ways you can affordably receive a skin cancer screening. For example, most health insurance plans only require you to pay the co-pay or coinsurance cost of visiting a specialist for your screening visit. And, many health care providers administer free skin cancer screenings, regardless of health insurance. You can check these helpful resources to learn when and where free skin cancer screenings are offered near you:
So, what preventive services are covered under the ACA?
BCBSM’s and BCN’s health non-grandfathered group and individual health plans cover certain evidence-based preventive services and immunizations with no cost sharing. This means that, under the provisions of the Affordable Care Act, some members do not need to pay a copay or coinsurance or meet a deductible first when receiving these services from a provider in our network.
Preventive services may include tests or services recommended by your doctor when they’re used to first detect or screen for a disease or condition. Examples of preventive services are those included in annual exams, such as health maintenance exams (physicals) or OB-GYN visits.
Some examples of common preventive services are:
• Certain screenings for cancer
• Checks of blood pressure and cholesterol levels
• Routine immunizations
• Regular physical exams, including pediatrician visits
• Counseling for tobacco cessation or to address obesity
• Coverage for certain women’s preventive services
Services are not considered preventive when they are for an existing illness or injury. Services used to monitor or follow up on an existing condition — or that aren’t on any of the lists of required preventive services — will not be considered preventive. If a service is not considered preventive, your share of the costs may still apply (such as the usual deductible, copay or coinsurance).
Your benefit plan outlines your specific coverage for these benefits, and your coverage may vary from the types of benefits described in these resources.
All of these preventive services, in addition to others not outlined above, must be covered in-full without you providing a co-pay, co-insurance or meeting the deductible. However, this applies only when the services are delivered by a network provider.
Want to learn more about health care reform? Visit mibluesperspectives.com/health-care-reform.
The information in this document is based on preliminary review of the national health care reform legislation and is not intended to impart legal advice. The federal government continues to issue guidance on how the provisions of national health reform should be interpreted and applied. The impact of these reforms on individual situations may vary. This overview is intended as an educational tool only and does not replace a more rigorous review of the law’s applicability to individual circumstances and attendant legal counsel and should not be relied upon as legal or compliance advice. As required by US Treasury Regulations, we also inform you that any tax information contained in this communication is not intended to be used and cannot be used by any taxpayer to avoid penalties under the Internal Revenue Code.
Photo credit: HealthierMI