Take Advantage of Preventive-Care Benefits

What are the new rules for free preventive health-care benefits in 2011?

As a result of the new health-care reform law, many insurance plans must now provide certain preventive-care screenings without charging deductibles or co-payments. Depending on your age, this rule may apply to blood-pressure, diabetes and cholesterol tests, mammograms and colonoscopies, flu shots, routine vaccines, well-baby and well-child visits, and other preventive services. The preventive-care page at Healthcare.gov provides a comprehensive list of the free preventive services and eligibility requirements.

You may have to pay extra for a doctor’s office visit if the preventive service is not the primary purpose of your visit. Also, health plans that use a network of providers are only required to offer these free preventive services through an in-network provider; you may have to pay extra if you use an out-of-network provider.

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These free preventive-care benefits may not apply if your health insurance plan has not made major changes to its costs and benefits since health-care reform was enacted (technically called a “grandfathered” plan). Ask your insurer or your employer’s benefits office if your plan qualifies.

Medicare beneficiaries also get an expanded roster of free preventive benefits. The “Welcome to Medicare” physical exam is now covered without cost sharing within the first year after you sign up for Medicare Part B. You can also get an annual wellness visit and personalized prevention plan. And Medicare will no longer charge co-pays or deductibles for preventive services, such as mammograms, cervical cancer and colorectal cancer screenings, cholesterol tests, flu shots, pneumonia shots and the hepatitis B shot, and certain kinds of prostate-cancer screenings. See the Manage Your Health section of Medicare.gov for a detailed list of who qualifies for these free services and how often you can take advantage of them. Also see Your Guide to Medicare’s Preventive Services for more information.

Depending on the screening, you may be charged a co-payment for the doctor’s office visit when you receive these services. These rules apply to people who are covered by original Medicare; the rules for free preventive services may be different if you have a Medicare Advantage plan.