WASHINGTON – Clarifying a much-anticipated benefit in the new health care law, the Obama administration on Wednesday issued rules outlining how millions of consumers will soon be able get many preventive medical services at no out-of-pocket cost.
Republicans and Democrats both have endorsed expanded preventive care such as cancer screening, and it is viewed as key to catching diseases early and ultimately controlling costs.
Here is how the new benefit will work:
Q.What does it mean the services will be free?
A.New insurance plans will be prohibited from charging consumers a co-pay or deductible for services getting the top recommendation from the U.S. Preventive Services Task Force.
These plans will also have to cover immunizations recommended for children and adults by an advisory committee of the Centers for Disease Control and Prevention.
Insurers could still charge consumers for services delivered out of network and for treating conditions identified by screenings.
In some cases consumers could also be charged if a preventive service is not billed separately from another service, such as an office visit.
Q.Which services would be covered?
A.The benefits vary depending on consumers’ age, sex and whether they are at higher risk for a medical condition.
The services covered include: colorectal cancer screening for adults over 50; hepatitis B screening and tobacco counseling for pregnant women; depression screening for adults and adolescents; HIV screening for adults at high risk; and obesity screening and counseling for adults and children.
Children would qualify for more than two dozen services, including vaccinations for influenza, diphtheria and tetanus, and screenings for hearing and vision impairment and autism.
Q.What about mammograms?
A.In a controversial move last year, the U.S. Preventive Services Task Force recommended that women between 40 and 50 do not need regular mammograms.
But lawmakers inserted a provision in the new law specifying that women older than 40 will still be able to get a mammogram screening every year or two at no cost.
Q.Will everyone qualify for this new benefit?
A.No. Only people in new insurance plans beginning after Sept. 23 or in existing plans that change substantially will be able to get the discounted preventive services.
The health care law exempts so-called grandfathered plans offered by employers that have not substantially changed since the legislation was signed in March.
To maintain grandfathered status, employers cannot substantially raise co-pays, deductibles and other employee contributions or lower their contribution to their employees’ premiums by more than 5 percentage points.
Q.How much difference will this make?
A.That’s difficult to say. Many experts and consumer groups are hopeful it will ultimately have a huge impact.
Tens of millions of Americans still do not get basic screenings for diseases such as colorectal and cervical cancer. Numerous studies have suggested that early detection of diseases as well as interventions to address bad habits such as smoking and overeating can improve health and productivity.
But it is still unclear how many people will take advantage of the less expensive services, some of which, such as dietary counseling for obese Americans, may not be readily available in some parts of the country.
Q.Will the added benefits drive up premiums?
A.They could. The administration estimated that the new benefits may push up premiums by 1.5 percent on average.
But officials at the Department of Health and Human Services noted that any premium increases may be offset as millions of Americans no longer pay out-of-pocket co-pays and deductibles.