Once an underused component of the health care world that benefits both employees’ health and employers’ health care spending, preventive care is now a mandatory part of any health benefits package.
Preventive care consists of measures taken to prevent diseases, rather than curing them or treating their symptoms.
There is significant research demonstrating that increased use of effective preventive services will result in less suffering from ailments that could have been prevented had they been detected and treated early on. Preventive care is often more cost-effective than treating diseases once symptoms appear.
Under the Affordable Care Act (ACA), private insurers—except for plans that have been grandfathered—are required to cover certain preventive services, free of cost sharing. Medical services such as immunizations, screening tests, medications and any other services that would help prevent and detect disease, injury and premature death fall under the umbrella of preventive care.
Preventive care services should be used by employees to lessen the cost and number of future medical claims and help them and their families stay healthy.
Preventive Care for Adults
The following types of preventive care are available to all adults within specified age ranges or risk groups.
- Aspirin use: Counseling on the use of aspirin for men ages 45 to 79 and women ages 55 to 79, when the potential benefit due to a reduction in myocardial infarctions outweighs the potential harm due to an increase in gastrointestinal hemorrhage
- Blood pressure screening: Routine measurements of adult blood pressure and treatment with anti-hypertension medication to prevent cardiovascular disease. Hypertension and related complications account for $100 billion in medical costs every year, yet only 1 in 3 people with hypertension actually controls it.
- Tobacco use screening: Screenings for adults at higher risk; tobacco users may receive intervention and cessation support. A comprehensive, effective smoking cessation program usually costs less than 50 cents per member per month, or less than $6 per member per year. You can save an average of $210 on yearly health care costs for each smoker who quits.
Preventive Care for Women
In addition to the services listed above, the ACA also mandates coverage for the following preventive services for adult women as part of all non-grandfathered health plans.
- Breast cancer genetic test counseling (BRCA): Screenings designed to identify women with increased risk of developing breast cancer due to family history. Women with positive screening results should receive genetic counseling and, if indicated after counseling, BRCA testing.
- Contraception: S. Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling, as prescribed by a health care provider for women with reproductive capacity.
- Osteoporosis screening: Screenings for women at high risk of developing osteoporosis starting at age 60, and for all women beginning at age 65.
Preventive Care for Children
Most health plans must also cover a set of preventive health services for children. These services must be provided at no cost to beneficiaries if they are requested from and delivered by an in-network provider.
- Behavioral assessments: Screenings for children at the following ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years and 15 to 17 years.
- Obesity screening and counseling: Screening for children beginning at age 6, and referral to comprehensive, intensive behavioral interventions to promote improvement in weight status.
- Vaccinations: Shots for diphtheria, tetanus, pertussis, Haemophilus influenza type B, hepatitis A, hepatitis B, HPV, polio, flu, measles, mumps, rubella, meningitis, pneumococcal disease, rotavirus and varicella; doses, recommended ages and recommended populations vary.
In addition to mandated no-cost preventive care, there are other existing preventive services that may be included by an insurer as part of a health group plan. These include things like adult vision and hearing screenings and vitamin and mineral supplements. Check with your insurer to see if additional preventive services are available for your plan’s recipients.
Maximizing Your Health Plan
How can you take advantage of the cost-saving potential of some of these preventive care services? Here are some ways that you can maximize your health care investment:
- Educate your employees on the preventive care services that your health plan offers, their potential risk factors and the benefits of preventive medicine.
- Find ways to make preventive care more convenient for your employees by working with nearby clinics, developing an on-site clinic or hosting a mobile van for vaccinations and screenings.
- Educate your employees on preventable health conditions. Your Austin Benefits Group representative can provide you with payroll stuffers, flyers and postings to help educate your employees.
For a complete list of preventive care options for adults, women, and children, download our Benefits Insights flyer here: Benefit Insights – Preventive Care
