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ACA & Women, ACA: Medicare & Medicaid

What can you do for your preventative healthcare?

The Affordable Care Act is based on the belief that prevention is the best framework for our health care system.  As the law has been implemented over the past two and a half years, incentives have been provided for better access to preventive care. We know that this is a necessary shift for women, as 1 out of 4 women reported going without preventive care because of out-of-pocket costs in 2008, according to the National Women’s Law Center.

Certain preventative health services not requiring a copay, co-insurance, or deductible have been available with certain stipulations since late 2010.  Here are some things you should know, so that if you are not receiving health care that is required by federal law you can help make sure you’re getting the benefits you deserve.

What is covered at no additional cost?

There is a large list of no additional cost preventative services, which is provided in more detail at the federal government’s healthcare site.  Some of the services include:

  • cancer screenings (such as mammograms and colonoscopies)
  • routine vaccinations (including measles, polio, or meningitis)
  • well-baby, well-child, and well-women visits
  • pregnancy care (such as counseling, screenings, and vaccines)
  • and many more

Beginning in August 2012, women can also access a collection of core preventative health services, including birth control,  anemia, STI, and cervical cancer screenings, as well as breastfeeding support and supplies at no out-of-pocket cost.

What is covered under which insurance plans?

It is important to note that these preventative services are available at no copay for individuals who have employer-provided plans or an individual health policy that was created after March 23, 2010.  Therefore, there are several instances where you will not necessarily receive these benefits or instances where fees can still be charged.

  • Know your network: If your insurance plan is uses a network of providers, know that your plan is only required to provide no pay preventative services through in-network providers.  Therefore, even if you can access preventative care from an out-of-network provider, you may be charged a fee.
  • Fees for Office Visits: If the preventative service is not the main purpose of the visit, or if your provider charges you separately for preventative services and office visits, you may have to pay a fee for other parts of the appointment.
  • Grandfathered Plans: If you are still under a plan which is exempt under the grandfather clause, these no copay/deductible preventative services may not be available to you at this point. As your plan changes from year to year, it will lose grandfathered status. It is expected that all plans will have to be in compliance within a few years.

Be aware.  What could happen?

You should be aware that all of these requirements of the ACA are not perfectly implemented yet.  It takes a lot of advocacy and education in order for doctors, patients, and insurance companies to understand what the law requires and actually uphold it in practice.

For example, some scenarios women have experienced include being charged ‘extra’ fees for a doctor’s visit, or a trip to the pharmacy where a pharmacist cannot not give you birth control at no charge because it is not the generic version.

If this is the case, check if any of the above conditions below apply to your plan, and if they do not, please make your story and voice heard.  There are many parts of the ACA which are still being detailed and regulated, so individuals need to share their experiences in order for policy advocacy groups (such as the Wisconsin Alliance for Women’s Health and the National Women’s Law Center) to compile subregulatory guidance advice to submit to the Department of Health and Human Services.

What should you do?

The National Women’s Law Center has created a campaign called Pills-4-Us, which has focused on making sure that pharmacists are allowing individuals access to both over-the-counter and prescription birth control, as well as the complete package of preventive services available under the law at no additional cost.

For more detailed information on how to enlist the assistance of the National Women’s Law Center in remedying a problem with your physicians, pharmacist, or insurance company, you can call their hotline at 1-866-PILL-4-US or contact them via email at pill4us@nwlc.org..  They also have fact sheets on what to do if your pharmacist won’t give you birth control pills or emergency contraception and pharmacy refusals.

It is individual Wisconsin women like YOU who will be the force that puts the ACA into action! Raise your voice!

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