~ From LifeHacker – Vitals – Beth Skwarecki ~
If you’re putting off a checkup or a tetanus booster because you think you’d have to pay a ton for it, we have good news. Even if you haven’t met your deductible, you still don’t have to pay a cent for most common types of preventive care.
Deductibles Don’t Work the Way You Might Think
Health insurance deductibles work very differently than car insurance deductibles. With a car, you have to cough up a certain amount of money before insurance will kick in—it’s a straightforward matter of numbers. So if somebody busts your headlight, you’ll pay for it out of pocket, because calling up your insurance company won’t bring you any benefit. You probably hope you never have to use your auto insurance at all—and if you’re a safe driver, and very lucky, maybe you won’t.
But it’s not realistic to expect to never use health insurance. Almost everybody needs some medical care, even if it’s just a checkup. There are two reasons why getting care, even with a high deductible, doesn’t cost as much as you would think:
- The insurance company can usually get you a lower rate than if you told the provider you would pay cash. Maybe an office visit costs $250, but the negotiated rate is $100. You still have to pay the $100, but the other $150 disappears into thin air.
- Better yet, the law requires most insurance plans to pay for certain preventive care with no cost to you. That’s no copays, coinsurance, or deductible charges. Actually free.
OK, nothing is free, so really it’s included in your premium. That means your plan already includes that checkup whether you get one or not—so don’t use cost as an excuse to put it off.
The Stuff You Don’t Have to Pay For
Here’s a partial list of what’s free to you, so long as you get it from an in-network provider. In general, checkups are free: adults get one annual physical without cost, plus you’ll see below that the care involved in a well-child visit or a woman’s annual gynecologist visit is also covered for free.
A major caveat: Some insurance plans are considered grandfathered and don’t have to offer the benefits below for free. (They might still be covered, but that’s up to the plan.) Grandfathered plans are slowly dying off, but 25 percent of people with employer-sponsored health insurance (so, roughly 11 percent of Americans) still had one in 2015, according to a Kaiser Family Foundation survey.
A plan that is otherwise not grandfathered might still be considered grandfathered for the starred items on the women’s health care list below. That’s because these recommendations were added later, so they got their own special grandfathering date. If you can’t tell from the plan’s website whether your plan is grandfathered or whether the care you want is fully covered, call up the number on your card and ask.
- Alcohol and Drug Use assessments for adolescents
- Autism screening for children at 18 and 24 months
- Behavioral assessments
- Blood Pressure screening
- Cervical Dysplasia screening for sexually active females
- Congenital Hypothyroidism screening for newborns
- Depression screening for adolescents
- Developmental screening for children under age 3, and surveillance throughout childhood
- Dyslipidemia screening for children at higher risk of lipid disorders
- Fluoride supplements for children without fluoride in their water source (age 6 months to 5 years)
- Gonorrhea preventive medication for the eyes of all newborns
- Hearing screening for all newborns
- Height, Weight and Body Mass Index measurements
- Hematocrit or Hemoglobin screening for children
- Hemoglobinopathies or sickle cell screening for newborns
- HIV screening for adolescents at higher risk
- Immunization vaccines for children from birth to age 18 —doses, recommended ages, and recommended populations vary:
- Diphtheria, Tetanus, PertussisHaemophilus influenzae type bHepatitis AHepatitis BHuman PapillomavirusInactivated PoliovirusInfluenza (Flu Shot)Measles, Mumps, RubellaMeningococcalPneumococcalRotavirusVaricellaLearn more about immunizations and see the latest vaccine schedules.
- Iron supplements for children ages 6 to 12 months at risk for anemia
- Lead screening for children at risk of exposure
- Medical History for all children throughout development (in other words, the part of the visit where they ask you a lot of questions)
- Obesity screening and counseling
- Oral Health risk assessment for young children (up to age 10)
- Phenylketonuria (PKU) screening for this genetic disorder in newborns
- Sexually Transmitted Infection (STI) prevention counseling and screening for adolescents at higher risk
- Tuberculin testing for children at higher risk of tuberculosis.
- Vision screening for all children
Starred items in this list are newer recommendations and some plans don’t have to cover them (see above).
- Anemia screening on a routine basis for pregnant women
- Bacteriuria urinary tract or other infection screening for pregnant women
- * Birth Control: Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling, not including abortifacient drugs
- BRCA counseling about genetic testing for women at higher risk
- Breast Cancer Mammography screenings every 1 to 2 years for women over 40
- Breast Cancer Chemoprevention counseling for women at higher risk
- * Breastfeeding comprehensive support and counseling from trained providers, as well as access to breastfeeding supplies, for pregnant and nursing women
- Cervical Cancer screening for sexually active women
- Chlamydia Infection screening for younger women and other women at higher risk
- * Domestic and interpersonal violence screening and counseling
- Folic Acid supplements for women who may become pregnant
- * Gestational diabetes screening for women 24 to 28 weeks pregnant and those at high risk of developing gestational diabetes
- Gonorrhea screening for all women at higher risk
- Hepatitis B screening for pregnant women at their first prenatal visit
- * Human Immunodeficiency Virus (HIV) screening and counseling for sexually active women
- * Human Papillomavirus (HPV) DNA Test: high risk HPV DNA testing every three years for women with normal cytology results who are 30 or older
- Osteoporosis screening for women over age 60 depending on risk factors
- Rh Incompatibility screening for all pregnant women and follow-up testing for women at higher risk
- Tobacco Use screening and interventions for all women, and expanded counseling for pregnant tobacco users
- * Sexually Transmitted Infections (STI) counseling for sexually active women
- Syphilis screening for all pregnant women or other women at increased risk
- * Well-woman visits to obtain recommended preventive services
For All Adults
- Abdominal Aortic Aneurysm one-time screening for men of specified ages who have ever smoked
- Alcohol Misuse screening and counseling
- Aspirin use for men and women of certain ages
- Blood Pressure screening
- Cholesterol screening for adults of certain ages or at higher risk
- Colorectal Cancer screening for adults over 50
- Depression screening
- Type 2 Diabetes screening for adults with high blood pressure
- Diet counseling for adults at higher risk for chronic disease
- HIV screening for all adults at higher risk
- Immunization vaccines for adults—doses, recommended ages, and recommended populations vary:
- Hepatitis AHepatitis BHerpes ZosterHuman PapillomavirusInfluenza (Flu Shot)Measles, Mumps, RubellaMeningococcalPneumococcalTetanus, Diphtheria, PertussisVaricellaLearn more about immunizations and see the latest vaccine schedules.
- Obesity screening and counseling
- Sexually Transmitted Infection (STI) prevention counseling for adults at higher risk
- Tobacco Use screening for all adults and cessation interventions for tobacco users
- Syphilis screening for all adults at higher risk
Now that you know what you can get without an extra charge, feel free to schedule that visit you’ve been putting off.