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UMMS primary care physician explains ACA changes in 2014

Affordable Care Act bringing extensive coverage for preventive services

diciembre 31, 2013
Ron Adler, MD

Beginning on New Year’s Day, the Affordable Care Act will provide extensive insurance coverage for preventive health services. As a result, patients may find themselves receiving additional screenings and care at their primary care visits, with no additional cost.

Under the ACA, preventive services which must be covered include, among others:

· adult and childhood immunizations;

· screening for cancers, cardiovascular conditions, depression, diabetes, HIV and other sexually transmitted infections;

· early childhood screening for autism spectrum disorders;

· counseling for dietary issues, tobacco cessation, and domestic violence;

· osteoporosis screening, contraception, and comprehensive breastfeeding support and counseling for women, including coverage for breast pumps; and

· abdominal aortic aneurysm screening for men of specified ages who have ever smoked.

“The widespread implementation of many facets of the law will include near-universal coverage for a wide variety of preventive care services without copayment or coinsurance charges – even when yearly deductibles have not yet been met,” said primary care physician Ron Adler, MD, assistant professor of family medicine & community health at UMass Medical School. “Prior to the ACA, many such services would not be covered by many insurance plans, and even patients who had insurance could have high out-of-pocket expenses for them.”

The mandated coverage is based on recommendations from the United States Preventive Services Task Force (USPSTF), an independent panel of scientists and clinicians whose recommendations for prevention are the nation’s most reliable and authoritative. The ACA requires coverage of all services rated “A” or “B” by the USPSTF, which means that there is high certainty that it produces a substantial or moderate net health benefit.

“We anticipate that the rates of patients receiving recommended services will rise with the new ACA-mandated coverage,” noted Dr. Adler, who cares for patients at Worcester’s Hahnemann Family Health Center, a family medicine residency training site for UMMS. “Patients should ask their health care providers about which screening and prevention services may be right for them.”

Adler does caution that there are some important ACA coverage exceptions to note. For example, the removal or biopsy of a polyp which is found during a covered colonoscopy would not be considered part of the preventive service, so there may be additional expenses which specific insurance plans may or may not cover.

Nonetheless, Adler points out that due to Massachusetts’ pioneering 2006 health care legislation, most people in Massachusetts have had health care coverage and access to a primary care provider since before the ACA. “For a long time, PCPs in our state have been working hard at all aspects of prevention, including immunizations, screening, and counseling. As a result, Massachusetts boasts some of the highest rates in the nation for these services.”