WASHINGTON (AP) - From counseling for kids who struggle with their weight, to cancer screenings for their parents, preventive health care will soon be available at no out-of-pocket cost under consumer rules the Obama administration unveiled Wednesday.
That means no copays, deductibles or coinsurance for those covered by the new requirements.
Administration officials speaking on condition of anonymity ahead of an announcement by first lady Michelle Obama said 41 million Americans will benefit initially, with the number projected to rise to 88 million by 2013. Many large company plans, which usually offer solid preventive benefits, will be exempt from the requirements.
Better preventive coverage is one of the goals of President Barack Obama's health care overhaul law, part of a shift to try to catch problems early, before high cholesterol leads to heart disease, for example.
Premiums will inch up by 1.5 percent on average, as the cost of preventive care is spread broadly across an entire pool of insured people.
For an individual, that can mean considerable out-of-pocket savings. For example, a 58-year-old woman at risk of heart disease could save at least $300 out of her own budget on recommended tests, ranging from diabetes and cholesterol screening, to a mammogram and a flu shot.
Research has shown that people tend to skip recommended preventive care if cost is an issue, and even a modest copayment can make a difference. Cost-free prevention was one idea that received widespread support during the contentious health care debate last year in Congress.
"We know that the best way to keep our families healthy and cut health care costs is to keep people from getting sick in the first place," Michelle Obama said in remarks prepared for the announcement.
The prevention requirements take effect for health plans renewing on or after Sept. 23, which means most beneficiaries will see them starting Jan. 1. Coincidentally, that's also when Medicare recipients get access to most preventive services at no out-of-pocket cost - another change under the health care law.
Under rules to be issued Wednesday by the government, health insurance plans have to cover four sets of preventive services at no additional charge to their members.
These include:
- Screenings strongly recommended with a grade of "A" or "B" by the U.S. Preventive Services Task Force, an independent advisory panel. Among them are breast and colon cancer tests, screening of pregnant women for vitamin deficiencies, tests for diabetes, high cholesterol and high blood pressure, as well as counseling to help smokers quit.
- Routine vaccines from childhood immunizations to tetanus boosters for adults.
- Well-baby visits to a pediatrician, vision and hearing tests for kids, and counseling to help youngsters maintain a healthy weight. These and other services are recommended under guidelines developed by the government and the American Academy of Pediatrics.
- Women's health screenings, also to include test called for under guidelines that are still in development and not expected to be be announced until Aug., 2011.
Many large employer plans will not be affected by the new requirements if they are considered "grandfathered" under the health overhaul law. Lawmakers created that exception so Obama could deliver on his promise that the law would not force wholesale changes in existing insurance plans. However, as employers make changes to their plans over time, many stand to lose the exemption, meaning they would have to comply with the law's requirements.