The past week has been full of news about the new rule, courtesy of health care reform, that makes birth control and a wide range of other preventative services free to the consumer, i.e. you. Free birth control sounds pretty great, especially for women who take expensive brand name contraceptives that are not covered by their insurance plan, or can’t afford the out of pocket cost for a hormone-free IUD. But, as with all “free” things, it is more complicated than telling your pharmacist you don’t plan on paying the bill this month, and unlike many free things, this plan includes more than just birth control.
So lets break it down. After the Affordable Care Act passed in March of 2010, it opened the door for the Department of Health and Human Services to require that insurance policies cover things they deem important. Just like insurance plans have to cover all or part of reconstructive surgery for breast cancer patients, HHS added a few more requirements onto insurance providers. Specifically, insurance plans must cover at no cost to the patient including a copay, the following services:
- well-woman visits;
- screening for gestational diabetes;
- human papillomavirus (HPV) DNA testing for women 30 years and older;
- sexually-transmitted infection counseling;
- human immunodeficiency virus (HIV) screening and counseling;
- FDA-approved contraception methods and contraceptive counseling;
- breastfeeding support, supplies, and counseling; and
- domestic violence screening and counseling.
What does that mean to you? If you have health insurance you won’t pay a dime for your annual exam, certain STD testing, birth control, breast pumps, lactation consulting and domestic violence counseling. But…how does this work? Can you just show up and ask Target to hand over that Medela pump at no cost to you? Not exactly.
First, you need to figure out when your plan year goes into effect. The new rules started on August 1st 2012, so if your health care plan starts its new year on August 1st, you are in luck! Most plans actually start on January 1st of the new year, so many women will wait until then for their “free stuff” and a few unlucky people have plan years that start on July 1st – so they have 11 months of waiting and paying for these services. Contact your benefits management team to find out when your plan year starts fresh. You also want to be sure your plan isn’t exempt from the new rules by being a grandfathered plan, i.e. a health care plan that has continuously provided coverage since March 2010 with no substantial changes to the coverage since then. Substantial changes include a change in premium, so very few plans are actually considered grandfathered, but those plans don’t have to start providing these services until 2014.
Assuming your plan year has just started and you are privy to these services, how do you go about cashing them in? Well for starters, when you book your annual well woman visit, ask if they have any standard tests that they run that don’t fall into any of the above categories so you know if you’ll have any out of pocket cost to pick up on your own. FDA approved contraceptives include the birth control pill, the ring, an IUD and others- check out this handy guide.
As for breast pumps and other supplies, that gets a little trickier. You’ll need to call your insurance provider and ask if their plan is going to cover the purchase of a breast pump, the rental of a hospital grade breast pump, or if you can select either option. If you already own a breast pump from a prior pregnancy your insurance will cover the purchase of new supplies – tubing, flanges, etc. Your insurance plan might let you buy it at a retail store and submit the receipt for reimbursement, or they might have a Durable Medical Equipment (DME) provider they want you to work through- and not jumping through every hoop could cost you money, so call and ask what their procedures are. When you set up a lactation consulting appointment, make sure they accept your insurance provider and ask if the type of appointment you have is covered under the ACA rules.
And finally, because we know that the “hot button” preventative care topics are not the only thing the ACA now requires your insurance plan to cover, check out this extensive list of preventative services you are already getting. It includes all sorts of things such as well baby visits, immunizations for adults and children, blood pressure screening, mammograms, and aspirin therapy for at-risk adults. Three cheers for a healthier America!
Daisy is a lawyer married to a lawyer (insert lawyer jokes here) living in a small condo in a big city with a new baby and beagle. She breaks up the legal-speak by blogging about life in Chicago, which is filled with escapades of urban living. In the summer she enjoys patio dining and in the winter wonders what she was thinking when she moved here. You can read more from Daisy on her blog, Just Daisy.
image Public Domain via Creative Commons