One of the best ways to control your out-of-pocket health care costs is to make preventative care a priority. Skipping preventative care can end up costing you even more in health care costs if it means delay in treating a condition. Even more importantly, skipping preventative care can have a profound impact on the quality—and length- of your life. Annual wellness checks and vaccinations help keep you healthy. Screenings such as cholesterol checks, mammograms and colonoscopies are a first-line defense in catching problems sooner than later.
Yet a national survey reports that 40% of Americans say they didn’t follow through on annual preventative medical care.
Even if you know deep down that an ounce of prevention is worth a pound of cure, that ounce can still seem too expensive if you are worried you’ll have to cover a hefty deductible, along with copays and coinsurance any time you dare to use your insurance.
Ready for some good news? Chances are you can get preventative care with no out-of-pocket costs.
The Affordable Care Act (ACA, also known as Obamacare) mandates that the vast majority of health insurance plans must offer 21 preventative care services without any deductible or copay, to all adults. There are additional preventative care services covered at no cost for children, and for women who are pregnant or could become pregnant.
About 85% of workers with health insurance through their job have plans that must abide by the ACA preventative care rules. All plans bought directly from the ACA exchange offer the full menu of preventative care that does not incur out-of-pocket costs.
Preventative Care That’s Not Going to Cost You
Your insurer should provide a list of all the preventative care you are entitled to. Or you can get up to speed at the ACA website. It’s quite a laundry list that includes blood pressure checks, colorectal cancer screening once you are 50, and a slew of immunizations. Blood screening for newborns is covered, as are 13 vaccinations for children. There are also a bunch of specific services and screenings available to pregnant women, or women who may become pregnant.
When Preventative Care Can Cost You
There are a few catches to be aware of. To obtain free preventative care you must stay in-network. That means making sure both the doctor you see and any facility you go to for testing is in your plan’s approved network.
Even when you stay in network, you may be charged for an office visit.
Treatment Beyond the Screening
If your preventative care exams, or testing turns up anything that requires treatment, deductibles and copays come back into play. Only the initial diagnosis of a condition is covered free of charge.
If you have a high deductible health care plan (HDHP) that is tied to a health savings account (HSA), you can reduce out-of-pocket costs for any treatment you may need, by tapping money you have saved in your HSA (and that your employer may have contributed to as well.) HSA dollars are more valuable than cash in your bank account because of valuable tax breaks. Money you contribute to an HSA reduces your taxable income for the year of the contribution, and when you use HSA dollars to pay for a qualified medical expense, there’s no tax due.
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