Copay-free preventive care: $0 out of your pocket for things like colonoscopies, mammograms, and birth control. It’s one of the most popular provisions of the Affordable Care Act, but is it really true? Thanks to new HHS guidance released last week, we can confirm that the answer is yes.

We all know that getting preventive care is crucial to staying healthy long-term. In the past, the high copay for many preventive services meant that many Americans simply went without. For example, in 2009, 45% of insured women delayed or did not receive a cancer screening because of cost.

Those days seemed to be over with the passage and implementation of Obamacare, which requires insurers to cover many preventive services without cost sharing.

However, as millions of Americans began to take advantage of their new benefits, some issues arose.Some insurance companies started coding services as “diagnostic” rather than “preventive” if a test showed even an abnormality. That is, what a patient thought was a copay-free preventive colonoscopy could end up costing $1,000 if polyps were found and removed- a routine part of the procedure.

Fortunately, the new HHS guidelines released last week will help prevent this practice. The rules address copay-free preventive services across the health care

  • Polyp removal is considered part of a preventive colonoscopy screening.
  • Insurers must cover testing for the BRCA gene, which dramatically increases the risk of breast cancer, if the test is deemed appropriate by a health care provider.
  • Over the counter products such as aspirin for heart care must be covered with a doctor’s prescription.
  • Insurers have to cover a full range of FDA-approved birth control methods: not just the pill, but IUDs and implants as well.

Expanding access to affordable preventive care is crucial to both improving health and reducing health care costs. Thanks to Obamacare, more Americans will be able to get the care they need to stay healthy.

Learn more about preventive service coverage from HHS’s Frequently Asked Questions, The Washington Post,  and this fact sheet from The National Women’s Law Center.

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