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Health Policy Brief: Preventive Services Without Cost Sharing



December 29th, 2010

new Health Policy Brief from Health Affairs and the Robert Wood Johnson Foundation describes the ways the Affordable Care Act mandates coverage for the complete cost of 45 preventive services, both for those with new private insurance plans and Medicare patients.

Preventive services include a wide range of clinical activities to avoid, detect, and slow the progression of disease. Examples include vaccinations, screenings for cancer or diabetes, and reducing cholesterol levels for those who have had heart attacks. While preventive services have the potential to help people live longer and healthier lives, they may also increase and redistribute costs across the health care system. Some preventive services are controversial because they can generate “false positive” and “false negative” test results. Some screenings, such as mammograms and computer tomography scans, may also expose patients to excessive radiation.

The United States Preventive Services Task Force (USPSTF) analyzes and grades the benefits of preventive services using letter grades from A to F.

  • Under the Affordable Care Act, new group and individual health plans must cover those services graded A or B without patient co-payments or deductibles. “Grandfathered” plans (those in existence at the time the health reform law was enacted) are exempted.
  • In addition to the benefits available to private insurance patients, as of January 1, 2011 Medicare beneficiaries will also receive an annual wellness visit and receive free influenza, pneumonia, and Hepatitis B vaccines without cost sharing.
  • Some exceptions to the cost-sharing rule include screenings covered by Medicare but not recommended by USPSTF. These include digital rectal exams for prostate cancer, glaucoma screening, and diabetes self-management training.

These new benefits are expected to increase the use of these services and the impact of greater use of preventive services is expected to grow over time.

About Health Policy Briefs:

Health Policy Briefs are aimed at policy makers, congressional staffers, and others who need short, jargon-free explanations of health policy basics. The briefs include competing arguments on policy proposals from various sides and the relevant research supporting each perspective. 

Previous policy briefs have addressed:

-Early Retirement Insurance: A new temporary program is designed to shore up health insurance coverage for early retirees – individuals between 55 and 64 — who have left employment and are not yet eligible for Medicare.

-Medical Loss Ratios:  The Affordable Care Act and implementing regulations require insurance companies to invest most of the premiums they collect on health care for policyholders.

-Grandfathered Insurance Plans: Certain existing insurance plans are exempt from some of the Affordable Care Act’s requirements.

Sign Up For Health Policy  Briefs

Health Policy Briefs offer more context than fact sheets but are more easily read than many other backgrounder papers. The information is objective and reviewed by Health Affairs authors and other specialists with years of expertise in health policy.

You can sign up for e-mail alerts from Health Affairs about upcoming briefs. The briefs are also available from the Robert Wood Johnson Foundation’s website. Please feel free to forward the briefs to any of your colleagues who are tracking health issues. And after you’ve taken a look, we welcome your feedback at: hpbrief@healthaffairs.org

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1 Trackback for “Health Policy Brief: Preventive Services Without Cost Sharing”

  1. health reform and Medicare in 2011
    August 23rd, 2011 at 9:53 am

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