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HHS: Insurers must offer free preventive health services
August 16th, 2010
WASHINGTON – The Obama administration has issued new rules that require health insurers to provide free coverage of a wide range of preventive health services. The rules are intended to improve access to and use of these services, which currently are often subject to deductibles, coinsurance or copayments.
Under the new regulations, which were issued by the Department of Health and Human Services (HHS), Labor and Treasury departments, such services as cancer screenings, including mammograms and colonoscopies; obesity prevention services; screening for vitamin deficiency during pregnancy; diabetes screening; cholesterol and blood pressure screening; and tobacco cessation services will be available to consumers without copayment or other direct cost on new health plans after September 23.
Also covered are routine vaccinations; preventive services specifically for children, including regular pediatrician visits; vision and hearing screenings; developmental assessments; and obesity screening and counseling.
The administration notes that Americans use preventive health services at about half of the recommended rate, often because of cost. According to HHS, cost-sharing — including deductibles, coinsurance or copayments — reduces the likelihood that preventive services will be used.
HHS estimates that 11 million children and 59 million adults have private insurance that does not adequately cover immunization. According to HHS secretary Kathleen Sebelius, the new rules will extend benefits to 31 million people in new employer-sponsored plans and 10 million people in new individual plans next year.
Making preventive services available free could be a boon for retail pharmacies that operate in-store clinics that perform such services by generating additional store traffic.
The administration points out that chronic diseases, which are often preventable, are responsible for 70% of deaths among Americans each year and generate about 75% of the nation’s total health care spending. Sebelius contends that 100,000 deaths could be averted each year if doctors and patients used five services: colorectal and breast cancer screening, flu vaccines, and counseling on smoking cessation and aspirin therapy to prevent heart disease.
While the new rules make a host of preventive services available at no direct charge to the consumer, insurers will be allowed to charge for medications and services needed to treat conditions that are detected in screenings.
A week after the White House issued the rules on preventive services, it unveiled new regulations intended to protect consumers from insurance company abuses by enabling them to appeal insurers’ decisions.
Now consumers in new health insurance plans have the right to appeal decisions that include claims, denials and rescissions made by their health plans. Not only decisions made internally by health plans but also outside, independent decision-makers’ judgments can be appealed.
As elements of the administration’s health care reform program are being rolled out, public perception of it is improving. According to a July tracking poll by the Kaiser Family Foundation, the percentage of people who view the program unfavorably fell 6 percentage points to 35% during the month.