By Lisa Zamosky
On August 1st, a provision of the Affordable Care Act that waives costs for a number of women’s preventive health services took effect. Women now have access to free contraceptives, along with seven other benefits, with no cost-sharing. These eight new services add to this list of preventive services already allowed under the law with no co-pays, co-insurance, or deductibles.
In my experience, among the most confusing aspects of the health reform law’s implementation is the fact that not all health plans have to comply with all parts of the law or at the same time.
So how do you figure out if and when you’ll have access to free preventive care as a new benefit of the Affordable Care Act?
Here are five things to do before your next visit to the doctor.
1. Figure out if you’re plan is grandfathered: Step one in figuring out whether you’ll owe money for birth control or your next mammogram or colonoscopy is to figure out if your health plan is considered “grandfathered.” Grandfathered health plans are those that were in place when health reform first became law in March, 2010 and that have made limited changes to their benefits. These plans are not required under the law to offer policyholders free access to preventive services.
The best way to determine your plan’s status is by calling the customer service number on the back of your insurance card and simply asking. In offering this tip, however, I must caution readers not to fall off their chair in surprise if the person on the other end of the line doesn’t know the answer or offers incorrect information.
The National Women’s Law Center offers useful scripts to follow once you’ve got a customer service representative on the line. Although this particular set addresses women’s preventive services, the scripts are useful for anyone inquiring about access to preventive care and whether or not it will be available to them at no cost.
If you get your insurance at work, it’s also a good idea to ask your company’s benefits administrator about your health plan’s grandfather status.
2. Learn about your plan’s timing: Just because contraception with no cost-sharing went into effect on August 1st doesn’t mean you’re entitled to free birth control pills tomorrow. In reality, policyholders don’t get access to the new benefits until their health plan renews. For most people, that’s at the start of the New Year.
Again, contacting your company’s benefits administrator or calling your insurance company to find out when these services become available for your particular plan is a good way to avoid surprise bills.
3. Help your doctor out: You’re not the only one confused about how changes under the health reform law impact your care and your costs. New regulations can send doctor’s offices into a frenzy; imagine having to figure out how these nuances come into play for hundreds of patients each week, all with different plans and rules.
To avoid confusion at your next doctor’s appointment, be sure to share with your doctor’s office staff the information you’ve gained by calling your insurer. If you’re able to provide that information in written form, that will only help things go more smoothly.
4. Stick within the network: Preventive services delivered outside of your insurance company’s network of providers may not come for free even if you’re now otherwise eligible for preventive care with no cost-sharing. You may be required to share in the cost of a wellness visit if you go to a physician outside of your plan.
5. Realize that only preventive care counts: Keep in mind that even if you’re entitled to a free colonoscopy, for example, if the screening unearths a polyp that requires further inspection, you’ll be required to pay for that additional care. What’s covered under the law is the preventive visit only.
Share your experience: Have you paid for a well visit or other preventive health service and later learned it should have been free to you? How did you get your money back? Tell your story in the comments section.