This week the Departments of Health and Human Services (HHS), Labor, and Treasury issued frequently asked questions (FAQs) to help insurance companies better understand the scope of coverage that is required (including contraceptive care) under the Affordable Care Act (ACA) and to help people better the ACA and benefit from it as intended.
This guidance follows recent Kaiser Family Foundation and research that reported variation in how the ACA contraceptive coverage provisions were being interpreted and implemented by health plans.
If an item or service is not covered but is determined medically necessary by the woman’s attending provider, there must be an easily accessible process for the woman to get that item or service;
If an insurer covers dependent children, recommended preventive services for women (such as preconception and prenatal care) must be covered for the dependent children as well (i.e., not just the parent(s) on the plan); and
Clarifies that insurance companies may still use reasonable medical management techniques within each of the methods of contraception (there are currently 18 identified by the FDA for women). For example, a plan can discourage the use of brand name over generic pharmacy items through cost sharing.
Obamacare is making health care work better for all of us, even if you already have insurance. It puts the health of your family first—ensuring access to free preventive care and protecting consumers from insurance company abuses.
71 Million Kids & Adults With Private Insurance Have Received No-Cost Preventive Care.
“HHS estimates that, as a result of the ACA, 71 million children and adults with private insurance, and 34 million Medicare beneficiaries have received no-cost preventive care. Enhanced federal matching funds in Medicaid are available to states providing all USPSTF-recommended preventive benefits without cost-sharing, but, to date, few states have made the changes required to gain the higher match rate.” “Health Reform-The Affordable Care Act Three Years Post-Enactment,” Kaiser Family Foundation, March 2013.
Discrimination By Insurance Companies For Children With Pre-Existing Conditions Was Banned.
“Coverage exclusions for children with pre-existing conditions were prohibited as of September 23, 2010. Insurers are no longer permitted to deny coverage to children due to their health status, or exclude coverage for pre-existing conditions. Protections for adults will take effect in 2014. In addition, lifetime limits on coverage in private insurance have been eliminated and annual limits are being phased out.” “Health Reform-The Affordable Care Act Three Years Post-Enactment,” Kaiser Family Foundation, March 2013.
Consumers Received $1.1 Billion in Rebates From Their Insurance Companies.
“Insurance companies that don’t spend at least 80 percent of its customers’ premium dollars on health care are required to provide rebates to policy holders. In 2012, the first year this rule was implemented, 12.8 million consumers received $1.1 billion in rebates.” “Health Reform in Action,” WhiteHouse.gov, accessed 6/5/13.
Seniors Have Saved More Than $6.1 Billion on Their Prescription Drugs Since 2010.
“Seniors who hit the gap in Medicare’s prescription drug coverage, often called the ‘donut hole’ now receive 50 percent discounts on covered brand name drugs. The new health reform law will provide additional savings each year until the coverage gap is closed in 2020.” “Health Reform in Action,” WhiteHouse.gov, accessed 6/5/13.