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Life Health > Long-Term Care Planning

PPACA: Use of Preventive Care May Grow

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The Patient Protection and Affordable Care Act (PPACA) could lead to an increase in use of preventive care services, according Towers Watson & Company.

Towers Watson (NYSE:TW), New York, has published this conclusion in a commentary.

PPACA will require health plans that are not “grandfathered” to provide coverage for services recommended by the U.S. Preventive Services Task Force and similar bodies.

Even plans that normally have high deductibles or other cost-sharing mechanisms must refrain from imposing those cost-sharing mechanisms in connection with the required preventive services. Plans can impose cost-sharing requirements in connection with the underlying office visit, but coverage for the preventive services provided by in-network health care providers must be “first dollar” coverage.

Depending on the age, sex and other characteristics of the insured, services that must be covered on a first-dollar basis may include vaccinations, mammograms, colonoscopies, and screenings for conditions such as depression, pregnancy and HIV.

The requirements will take effect in plan years starting on or after Sept. 23.

Employers that maintain “grandfathered” status for their plans, by keeping the plans roughly the same, can avoid having to meet the preventive care requirements, but Towers Watson is expecting more than half of large employer plans to lose grandfathered status within a few years.

The new preventive care benefits mandate probably will add about 1% to 2%, or about $100 to $200 per year per employee in a typical large health plan, to total plan costs, Towers Watson estimates.

The increase caused by the preventive care mandate will come on top of the underlying plan cost increase, which likely will be about 8% to 10%, Towers Watson predicts.

Insurers and administrators will have to spend money to update claim processing guidelines and claim payment systems to accommodate the new preventive benefits rules, the firm says.



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