Q. Must health insurance companies offer free cancer screenings and other preventive health benefits? If so, are they really free?
A. Yes, under the health care reform law, various preventive health care services are free. Most new individual health insurance policies and employer-sponsored health plans must offer these benefits without charge.
According to the U.S. Department of Health and Human Services, 41 million people will able to take advantage of the free services. Although insurers may raise premiums to cover the cost of providing free preventive care, the estimated 1 to 2 percent rate increase would be offset by a reduction in consumers' out-of-pocket spending.
In one example, HHS says, a 58-year-old woman would save about $300 for recommended vaccines, tests and screenings.
Free preventive care services for adults include:
- diabetes screening
- colorectal cancer screening
- high blood pressure screening
- tobacco cessation counseling
- screening for depression
- dietary counseling
- HIV screening for those at risk of the disease
- screening for obesity and weight loss counseling
Services for men:
- cholesterol screening (35 years and older)
Services for women:
- mammograms every year
- cervical cancer screenings
- colorectal cancer screening
- osteoporosis screening
There are also free benefits for pregnant women, infants and children. The government website Healthcare.gov offers more details on recommended preventive care.
There are some instances, however, when patients can be charged for preventive care. They may have to pay a share of the cost if the service was billed separately from an office visit or if it was provided by a doctor or other professional who is not part of the insurance plan’s provider network.
Also, some grandfathered plans may be exempt from the requirements because only new plans sold after Sept. 23, 2010, have to follow the requirement for free preventive care. If a plan has not significantly changed its benefits or premiums since the health reform bill was signed into law on March 23, 2010, it is exempt.
People in original Medicare also receive free preventive services, and most Medicare Advantage plans already offer this benefit. The Agency for Healthcare Research and Quallity has a simple tool that allows you to plug in your age and gender to see what preventive care services are recommended for you.
Nearly 8 million federal workers and their families who receive health coverage through the Federal Employees Health Benefits Program will have access to free preventive care benefits by 2013. But many insurers in the program have already reduced or dropped charges, or will do so before the deadline, a spokesman for the Office of Personnel Management said.
Why these services are free
Cancer, heart disease, diabetes and other often preventable chronic diseases are responsible for seven out of 10 American deaths every year and consume 75 percent of our health spending, Health and Human Services chief Kathleen Sebelius said when she unveiled the new requirements in July.
“According to one study, if people got just five preventive services when they needed them — colorectal and breast cancer screening, flu vaccines, counseling to help them stop smoking and regular aspirin use — we would save 100,000 lives each and every year,” she said.
Yet only one in four adults from 50 to 64 years old is up to date with basic recommended cancer screenings and other preventive health care, said AARP spokesman Jordan McNerney. In the Philadelphia region, for example, 45 percent of adults in this age range did not have a test for colorectal cancer.
“Quality health care is about keeping people healthy, not just treating them when they’re sick,” said McNerney.
Susan Jaffe of Washington, D.C., covers health and aging issues. She is the author of the Bulletin’s column Health Care Reform Explained: Your Questions Answered.