What You Need to Know
about Preventive Health Care
May 1, 2013
Vol. 9, Issue 5
When preventive health care is and is not covered becomes important with common, expensive services. And, a colonoscopy may be the first one that comes to mind. That can cost more than $1,000, so in this issue, I’ll explain the two main issues that impact preventive health care coverage.
How to Tell If Your HSA Plan Covers Preventive Care
Let’s start with the simple part. If your policy was purchased after March 22, 2010, colonoscopies and other forms of recommended preventive health care are covered without co-insurance or co-pay charges. And, that’s true of every year whether you meet the deductible or not.
If your plan is from before March 23, 2010, it’s known as a grandfathered plan. These plans are exempt from certain requirements under the new healthcare reform laws, commonly referred to as Obamacare. Even though these plans are not required to cover preventive care, we are currently encouraging most clients who have grandfathered plans to keep them for now rather than switch to a new plan. That is because we expect much larger rate increases on the new plans that will be required to cover anyone, regardless of pre-existing conditions.
In case you don’t recall how old your coverage is, your insurance is required to explain whether you have a grandfathered plan in the documentation you are sent. With most grandfathered plans preventive health care is not be covered until you have met the policy’s annual deductible. So I wanted to make sure you are aware of our source for lab work that is very highly discounted.
How to Get Steep Discounts for Lab Tests
HSA for America has contracted with Direct Labs to make their lowest pricing available to our clients. After joining (and there is no cost to do so), you may order your lab tests.
I’ve personally tested the service by ordering a standard group of tests called the Comprehensive Wellness Profile. I did that to check the status of my kidney and liver function, infection and nutrition, risk of diabetes and risk of heart disease.
This profile also shows total cholesterol, LDL, HDL, triglycerides, liver enzymes and many other factors. The test might have cost over $565 if done at a hospital or doctor's office, but I only paid $97.
You can even use this testing service when your doctor orders tests. Just explain that you are paying for the tests yourself since you have not yet met the policy deductible. You can order the tests online, go have your blood drawn without making an appointment, and get results online within 48 hours.
How to Tell Whether You’ll Be Charged for a Colonoscopy
Let’s say you do have a policy that pays for recommended preventive care. The other big issue that determines whether you’ll be charged for a colonoscopy is the way the doctor categorizes the test. Until recently, a colonoscopy was likely to be covered if no polyps were found and removed. Patients were unhappily surprised with a big bill if polyps were removed.
Recent clarification has added coverage even when polyps are removed, but how your doctor’s office bills for recommended preventive services still matters. If services are billed as diagnostic, that bumps you out of the preventive category so you lose coverage.
To avoid a nasty surprise, talk to your doctor before you have tests done. Preventive services vary depending not only on what billing codes are used, but also depending on your age. Colorectal cancer screening, for instance, is recommended for people at average risk starting at age 50.
If your parents have already enrolled in Medicare, they will have a co-payment when a polyp is removed during a screening colonoscopy. Medicare does cover many types of recommended preventive services with no out-of-pocket costs, though.