Are you relying on a high deductible health plan (HDHP) to pay for your major medical costs? Many families and business owners have been forced to switch to these high deductible plans in order to keep monthly premium expenses affordable.
About a quarter of all companies now offer HDHPs as the only option for their employees according to consultant PwC’s annual Health and Wellbeing Touchstone Survey for 2016. Seventy-two percent of firms offer a high deductible plan as an option, which can be attractive because of the lower monthly cost. And individuals who don’t have employer-sponsored benefits often purchase HDHPs to keep their monthly insurance expenses from rising.
The idea behind HDHPs is that consumers can shop around to get the best prices for medical procedures – but the fact is that most people don’t know how to do that, or don’t have time in an urgent care situation to compare prices.
Even if you don’t have the time and ability to shop around for less expensive medical care and more affordable doctors, there are some things you can do to minimize your out-of-pocket expenses. The Affordable Care Act has identified 19 health services that all Marketplace health plans must pay for even if you haven’t met your deductible. Many other plans will also pay for these services without regard to the deductible. To patients, these services are free – that means no co-pay – from providers in your network. Be sure to double check with your provider to make sure your plan qualifies.
Here are the free services you may be able to receive:
- Abdominal aortic aneurysm screening.
What it is: An abdominal aortic aneurysm (AAA) is a weak place in the wall of the aorta, your body’s main artery. If the weak wall of the artery bursts, you could experience internal bleeding that could be fatal. The test uses a painless ultrasound to check the artery for any issues.
Who qualifies: If you are a man between the ages of 65 and 75, and have ever smoked, you can be tested free for AAA.
- Alcohol use assessment.
What it is: You can receive screening from a medical professional to determine if your alcohol use is potentially damaging your health. Your doctor may also be able to provide counseling if you need it.
Who qualifies: Anyone whose consumption of alcohol is affecting their performance at school or work, their relationships, or their health.
- Aspirin use.
What it is: Taking aspirin daily might help if you are at risk of heart disease or stroke. Aspirin acts as a mild blood thinner and prevents blood clots.
Who qualifies: Anyone who is at increased risk of blood clots, primarily men and women from ages 50 to 59 who smoke or have high blood pressure, high cholesterol, or diabetes.
- Blood pressure screening.
What it is: A blood pressure test shows how hard your heart has to work while pumping your blood. The screening process uses a cuff around your arm to check the pressure in your arteries when your heart beats and when your heart relaxes. Screening also includes assessing your risk factors.
Who qualifies: Anyone over age 18 qualifies for a free blood pressure screening. Those age 40 and older or at higher risk should have the test done annually. Those between the ages of 18 and 40 only need it every three to five years.
- Cholesterol screening.
What it is: Cholesterol is a part of everyone’s diet, but in some people this waxy substance builds up in the blood vessels and leads to heart and circulation problems. High cholesterol levels may be the result of genetics, high blood pressure or diabetes, taking certain medications, or being overweight. A cholesterol screening involves a simple blood draw and a test that checks for excess cholesterol in your blood. You may need to fast before having the test done.
Who qualifies: Anyone at risk, but usually men and women over age 40.
- Colorectal cancer screening.
What it is: Colorectal cancer is any abnormal cell growth in your colon or rectum. There are a few different types of screening tests from a simple check for blood in your feces to a colonoscopy where a medical professional uses a small camera to look for polyps and growths in your intestinal tract.
Who qualifies: Men and women ages 50 to 75 should be checked for colorectal tumors. The type of testing depends on your medical professional’s advice and your insurance coverage.
- Depression screening.
What it is: Depression is a mental condition where you lose interest in things you used to enjoy and may even feel hopeless or even suicidal. Some other medical conditions, like thyroid imbalances, can cause similar symptoms. Your doctor can assess your symptoms and determine if depression is an issue for you.
Who qualifies: Anyone who feels symptoms of depression.
- Diabetes Type 2 screening.
What it is: Diabetes causes too much glucose to remain in the blood, and the condition can lead to fatigue, organ failure, or loss of feeling in your hands and feet. Screening involves assessing your risk factors and checking your blood for excess sugar.
Who qualifies: Any man or woman with high blood pressure or at higher risk of the disease. Some diet counseling for adults with signs of pre-diabetes may also be covered.
- Diet counseling.
What it is: Nutritional experts can help you create a diet that will reduce the risk of developing diabetes, heart disease, and other chronic conditions that are affected by the foods you eat.
Who qualifies: Adults with risk factors for diabetes, high blood pressure, and some other chronic conditions.
- Hepatitis B screening.
What it is: Hepatitis B is a liver disease that can be transmitted between people. Screening can be done with a blood test that shows antigens produced in response to having the infection.
Who qualifies: Those who are most at risk come from other countries where there is a high rate of Hepatitis B. Other risk factors include HIV, use of intravenous drugs, or living with people who have the disease. You may also qualify for screening if you have not been vaccinated for Hepatitis B.
- Hepatitis C screening.
What it is: Hepatitis C (HCV) is a liver disease. Screening is done with a blood test that detects antibodies to HCV infection.
Who qualifies: Anyone who was born between 1945 and 1965 can be screened, as well as anyone who had a blood transfusion or organ transplant before 1992 or used drugs intravenously.
- HIV screening.
What it is: HIV or human immunodeficiency virus is the virus that can cause AIDS. Screening is done with a blood test.
Who qualifies: Any person between ages 15 and 65. Sexually active women may qualify for additional HIV counseling.
- Immunizations for adults.
What it is: Immunizations are shots that produce an immune response in the body, making it easier to fight off a disease if exposed. Covered immunizations include Hepatitis A and B; measles, mumps, rubella and chicken pox; diphtheria, tetanus, and pertussis; and influenza.
Who qualifies: It depends on the specific immunization. For example, the influenza immunization is usually covered for all adults as part of preventative care.
- Lung cancer screening.
What it is: Lung cancer is the abnormal growth of cells in the lungs, often caused by tobacco use. The screening test is a low-dose CT scan, which is a little like a high-tech x-ray.
Who qualifies: Men and women ages 55 to 80 who currently smoke or who have smoked regularly in the past 15 years.
- Obesity screening and counseling.
What it is: Obesity is being a significant amount over your ideal weight. Excess weight can lead to developing heart disease, diabetes and other chronic conditions. Screening includes weighing and measuring to determine your Body Mass Index (BMI) and offering counseling to help you establish healthy habits for weight loss.
Who qualifies: Anyone who is considered obese based on their BMI.
- Sexually transmitted infection (STI) prevention counseling.
What it is: Information on how to avoid diseases like HIV, Hepatitis B, chlamydia, gonorrhea, and other infections that are transmitted via sexual contact.
Who qualifies: Any adult who is sexually active and at high risk of contracting STIs.
- Syphilis screening.
What it is: Syphilis is a specific sexually transmitted disease caused by bacteria. It starts with a rash or sores and can lead to nerve and brain damage if not treated.
Who qualifies: Any adult who is sexually active and at high risk.
- Tobacco use screening.
What it is: Tobacco use can cause multiple health issues, including increased risk of some cancers, lung disease, and heart disease. Screening can evaluate your use and assist you with finding ways to stop.
Who qualifies: Any adult who uses tobacco products.
What it is: A mammogram is an X-ray picture of the breast. Doctors use a mammogram to look for early signs of breast cancer. Regular mammograms are the best tests doctors have to find breast cancer early, sometimes up to three years before it can be felt.
Who qualifies: Any woman qualifies and it is recommended beginning at age 40 and continuing annually.
While the Affordable Care Act mandates that insurance plans cover these services at no additional cost, you should be sure to contact your insurer and make sure you understand the exact scope of coverage.
These services can help you make a high deductible health plan work better for you, but there still may be some challenges with your coverage. If you need additional health care coverage to fill in the gaps that your HDHP creates, contact us for information on supplemental insurance.
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