Medicare, Women’s Benefits—

Latest Affordable Care Act Provisions

Providing No-Cost Preventative Services

In Connecticut, the Affordable Care Act — the new health care law — helped 220,555 individuals with original Medicare to get at least one preventive service at no cost to them during the first six months of 2012.

According to Health and Human Services (HHS) Secretary Kathleen Sebelius, that number only represents 52 percent of those eligible for these services in Connecticut. This figure also includes 33,116 in Connecticut who have taken advantage of the Annual Wellness Visit provided by the Affordable Care Act.

Nationwide, more than 16 million with original Medicare received at least one preventive service at no cost to them so far in 2012, including 1.35 million who have had an Annual Wellness Visit. In 2011, 32.5 million people in Medicare received one or more preventive benefits free of charge.

“Millions of Americans are getting cancer screenings, mammograms, and other preventive services for free thanks to the health care law,” said Secretary Sebelius. “These new benefits, made possible through the health care law, are helping people stay healthy by giving them the tools they need to prevent health problems before they happen.”

Prior to 2011, people with Medicare faced cost-sharing for many preventive benefits such as cancer screenings. Through the Affordable Care Act, preventive benefits are offered free of charge to beneficiaries, with no deductible or co-pay, so that cost is no longer a barrier for seniors who want to stay healthy and treat problems early.

The law also added an important new service for people with Medicare — an Annual Wellness Visit with the doctor of their choice — at no cost to beneficiaries.

Under the new law, 47 million women nationally became eligible to access eight new prevention-related health care services without paying more out of their own pocket beginning August 1.

‘A Sigh Of Relief’

Previously, some insurance companies did not cover these preventive services for women at all under their health plans, while some women had to pay deductibles or co-pays for the care they needed to stay healthy. The new rules in the health care law requiring coverage of these services take effect at the next renewal date — on or after August 1, 2012 — for most health insurance plans.

According to a new HHS report also released this week, approximately 47 million women are in health plans that must cover these new preventive services at no charge. Women, not insurance companies, can now make health decisions that will keep them healthy, catch potentially serious conditions at an earlier state, and protect them and their families from crushing medical bills.

Teresa Younger, the executive director of Connecticut’s Permanent Commission on the Status of Women (PCSW), said eligible women “throughout the state — and across the nation — can breathe a sigh of relief” as a result of these key provisions of the Affordable Care Act going into effect.

“Many critical preventive care services will be available with no co-pays or deductibles for women with employer-sponsored health insurance,” Ms Younger said. “Some of these health-enhancing — and in some cases life-saving — services include gestational diabetes screening, HPV DNA testing, HIV screening and counseling, contraception and contraceptive counseling, breastfeeding support and supplies, and domestic violence screening.”

She said the PCSW applauds those in Connecticut’s Congressional delegation “who worked so hard to ensure that women’s health — and especially these all-important preventive measures — is protected.”

The eight new prevention-related services are:

*Well-woman visits.

*Gestational diabetes screening that helps protect pregnant women from one of the most serious pregnancy-related diseases.

*Domestic and interpersonal violence screening and counseling.

*FDA-approved contraceptive methods, and contraceptive education and counseling.

*Breastfeeding support, supplies, and counseling.

*HPV DNA testing, for women 30 or older.

*Sexually transmitted infections counseling for sexually-active women.

*HIV screening and counseling for sexually-active women.

These services are based on recommendations from the Institute of Medicine, which relied on independent physicians, nurses, scientists, and other experts as well as evidence-based research to develop its recommendations.

Exceptions To The Law

Group health plans and issuers that have maintained grandfathered status are not required to cover these services. In addition, certain nonprofit religious organizations, such as churches and schools, are not required to cover these services.

The Obama administration will continue to work with all employers to give them the flexibility and resources they need to implement the health care law in a way that protects women’s health while making common-sense accommodations for values like religious liberty.

Health services already provided under the health care law include folic acid supplements for women who may become pregnant, Hepatitis B screening for pregnant women, and anemia screening for pregnant women.

Women Medicare beneficiaries may already receive such preventive services as annual wellness visits, mammograms, and bone mass measurement for those at risk of osteoporosis and diabetes screening.

Because of the Affordable Care Act, men and children are also able to take advantage of preventive services at no extra charge under the health care law. These services include flu shots and other immunizations, screenings for cancers, high blood pressure and cholesterol, and depression.

To learn more about the health care services eligibility at no extra charge under the Affordable Care Act, visit www.healthcare.gov/prevention.

For more information on Medicare-covered preventive services, visit: www.healthcare.gov/law/features/65-older/medicare-preventive-services/index.html

To learn what screenings, vaccinations, and other preventive services doctors recommend for individuals and their family members, visit the myhealthfinder tool at www.healthfinder.gov.