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Preventive Services Coverage Uneven Despite ACA Requirements

Preventive Services Coverage Uneven Despite ACA Requirements

May 20, 2014 — The Affordable Care Act (PL 111-148) requires health plans to cover many preventive care services at no out-of-pocket cost to beneficiaries, but confusion among insurers and providers has left some consumers with unwarranted charges, Politico Pro reports.

The ACA's preventive services provisions were among the first benefits to take effect after the law was enacted in 2010, according to Politico Pro. The core list of services includes preventive services recommended by the U.S. Preventive Services Task Force; the list has since been expanded to include additional services for women and children.

The preventive services coverage is meant to help people stay healthy and address conditions before they become more complicated and costly to treat. For example, for women, the covered services include breast cancer screenings, pap tests, contraceptives and breastfeeding support.

However, women's health advocates and other experts say the benefits are being applied "unevenly," with both consumers and insurers unclear on how to distinguish between preventive care and other medical services, Politico Pro reports.

Experts Comment

Judy Waxman, vice president for health and reproductive rights at the National Women's Law Center, said, "Things are moving in a very positive direction, but we're still getting reports of real problems." She said that while insurers are required to cover all FDA-approved contraceptives -- including pills, patches and intrauterine devices -- some plans have declined to cover certain methods.

Amy Allina, deputy director of the National Women's Health Network, said that women "need strong enforcement of this provision" from both HHS and "state insurance officials." She added, "And until it becomes the established norm, we need to educate women about what they're supposed to be getting so they can demand it."

Meanwhile, Tim Jost, a law professor at Washington and Lee University, said that part of the problem is that the regulations do not clearly outline which services are considered preventive in some cases. "There are a number of preventive services where the insurers are not quite sure what they're supposed to cover," he said. For example, if a patient receives a screening, it is not always clear whether follow-up treatment is also covered if a problem is detected (Norman, Politico Pro, 5/19).