Under Obamacare we were sold on the idea of MEC, Minimum Essential Coverage and all the “free” preventive services that we’d get like certain screenings, checkups, and immunizations. These two features of Obamacare were created for different reasons and therefore will have different impact on your wallet.
MEC, Minimum Essential Coverage is the PPACA’s attempt at national standardization, making sure that all health insurance plans provide coverage for certain things. How the services are covered and what YOU will pay out-of-pocket for these services varies from plan to plan.
On the other hand, Preventive Services are just that, services designed to prevent illness in the form of checkups and screenings that will cost you no more out of pocket because under the PPACA these services cannot charge you a co-pay or co-insurance fee as long as you use an in-network provider. There is a caveat with getting those “free” Preventive Services, once you go beyond the superficial “Preventive” service, for instance if your healthcare provider orders more tests, you’ve gone into the “Diagnostic” area so that those additional services will not be “free.”
It will be hard to know whether your service has drifted into the non-free diagnostic without asking your healthcare provider every step of the way whether what they’re doing is part of your PREVENTIVE coverage. You MUST ask the question to avoid charges you didn’t expect.
The two features are costing or are blamed for increased costs of health insurance, for reduced choice in health insurance, and for charging everyone for services that they don’t necessarily want to pay for because they don’t need them, such as the extensive women’s health provisions that don’t allow men to opt out even when something as simple as a PROSTATE screening is NOT included for men.
Why read on? Because during the excitement of being politically moved to support one side or the other, we got bamboozled and bought the sales pitch of either side instead of the reality. Now, years after enactment, we’re realizing that some things never change…More coverage means more money in premiums or trading off coverage in one area for coverage in another, the THIN OPTIONS problem where people find they have reduced choice under their plans for needed medical care and treatment.
Not everyone was ignoring reality. Both the effort at standardization, MEC, and preventive services have been used as part of the O-blama-Care arguments about skyrocketing health insurance costs. In 2011, factcheck.org , in an article entitled, “FactChecking Health Insurance Premiums,” attributed the rise in health insurance premiums from 2010 to 2011 to several factors including, “…the increase caused by the law is a result of the increased benefits it requires.”
Obamacare fans failed to take note of this fact, that in the health insurance world, there is no such thing as additional coverage without an additional price tag, even for supposedly “free” screenings.
Since 2008, I have shouted the warning of this fact. On February 20, 2008, in my post, “Coding deaths from cancer: How it’s counted,” (http://conoutconsumer.blogspot.com/2008/02/coding-deaths-from-cancer-how-its.html)
I said, “The issue is not whether someone should have preventive screenings, if that's what you do, that's what you do, there's certainly enough justification for such activity, the issue is cost/benefit. If the current "empowered" craze of prevention distracts consumers away from the 43% rise in medical care costs in the last five years, or the higher premium/less coverage model of insurance, then our prevention happy model will end with continued rises in illness and death because what happens if preventive screenings indicate you need medical care? Then what.”
Yeah, 2008, before Obamacare.
For consumers, O-blama-Care news about hospitals that aren’t participating in insurance plans, doctors threatening to reject insurance and other stakeholder arguments are irrelevant, their interests only overlap consumer interests. Our interest is obtaining needed medical care and treatment in a timely fashion at an affordable price when we need it.
QUICK FIX: By our standards, federal standardization of policies is not necessarily a bad thing BUT, for me, the take away is that the “free” Preventive services under the PPACA should have been PART of the STANDARDIZATION REQUIREMENTS SPELLED OUT IN MEC (Minimum Essential Benefits) INSTEAD OF BEING A “FREE” category.
1-By getting rid of “free” preventive services but including those requirements of coverage as part of essential benefits, the goal of making sure these important screenings and checkups are covered by all insurance plans is addressed, you don’t need to wonder whether your plan covers them. As part of MEC, you would need to examine HOW your plan covers them, just as you do now for every other service.
2-In the O-blama-Care scenario, by getting rid of the “free” stuff, insurance companies would no longer have that coverage as an excuse for raising prices.
After all, preventive services that negatively impact coverage of needed medical care and treatment by raising those costs of premiums and/or co-payments, co-insurance or raising deductibles, or by limiting choices of healthcare providers who provide in-network services if you get sick, or by making it harder to use the coverage you’ve purchased through new requirements for pre-authorization, all strategies currently being used/abused by insurance companies have limited value to consumers who only purchase health insurance to help cover the cost of the unknown IF, IF they are sick.
3-Right now, if you use a “free” preventive service you need to first make sure that you use an in-network provider, but in addition, you need to make sure that in that office visit you aren’t advised or provided with additional lab tests, or referrals, or anything else that will be coded as “DIAGNOSTIC” rather than “PREVENTIVE.”
You need to ask your healthcare provider whether each thing they’re doing, whether it’s taking blood, adding in an additional test or anything else is part of your “PREVENTIVE and therefore FREE” coverage, or else you risk getting unexpected bills for NON-Preventive services which will be covered like other services under your plan. This confusion will likely result in many charges that you didn’t anticipate.
There’s enough blame to go around when it comes to why many of us and many in government didn’t seem to know what on earth the Patient Protection and Affordable Care Act did. One of the reasons is the choppy way information was delivered, intentionally to consumers, by politicians or even talk show hosts trying to make certain features look GOOD or BAD.
But consumers dropped the ball, and did not use the savvy they show in other SHOPPING experiences by looking beyond the sales pitches and asking additional questions, such as, “How will insurance companies provide additional coverage without charging more?”
