The Health Resources and Services Administration (HRSA) of the U.S. Dept. of Health and Human Services (HHS) recently announced new preventive care and screening guidelines aimed at reducing out-of-pocket expenses for women, infants, children, and adolescents. The new guidelines take effect for plan years beginning in 2023.
Under the Affordable Care Act (ACA), certain group health plans and insurance issuers must provide coverage for preventive health services with no out-of-pocket cost. More than 150 million people with private insurance, including 58 million women and 37 million children, currently receive preventive services with no cost-sharing due to the ACA.
What are the updated guidelines for women’s preventive care?
The Women’s Preventive Services Guidelines help clinicians determine what services they should routinely provide to their patients. In December 2021, HRSA accepted updated guidelines for:
- Well-woman preventive care visits
- Breastfeeding services and supplies, including double electric breast pumps
- Access to contraceptives and contraceptive counseling
- Screening for human immunodeficiency virus (HIV)
- Counseling for sexually transmitted infections (STI)
- Counseling for prevention and reduction of obesity in midlife women (ages 40-60)
What updates have been issued for children’s preventive care?
The Bright Futures Program develops recommended evidence-informed guidelines for preventive care screenings and routine visits for newborns through adolescents up to age 21. Also accepted in December 2021, updated guidelines include:
- Universal suicide risk screening for ages 12-21
- Behavioral, social and emotional health screening
- Cardiac arrest or death risk assessment for ages 11-21
- Hepatitis B viral infection risk assessment for ages Newborn-21
Do the updates eliminate all preventive care cost-sharing?
No, the new guidelines do not eliminate all preventive care cost-sharing. That’s where consumer-directed healthcare accounts can help.
FSAs and HSAs
Flexible Spending Accounts (FSAs) and Health Savings Accounts (HSAs) use pre-tax funds set aside by the employee for out-of-pocket medical expenses not covered by insurance. Some of the preventive care products and services eligible for purchase with these accounts include:
- Annual physical exams
- Eye exams
- Dental checkups
- Diagnostic devices like blood pressure monitors
- Co-pays, co-insurance and deductibles
- Vaccinations
HRAs
Health Reimbursement Arrangements (HRAs) are also used to pay for out-of-pocket medical expenses, but the sponsoring employer funds these accounts and chooses the eligible expenses. There are four different types of HRAs (standard HRAs, ICHRAs, EBHRAs, and QSEHRAs) that apply to a variety of employment situations and healthcare-related expenses.
The Centers for Disease Control and Prevention (CDC) has found that preventive care, paired with lifestyle changes, can reduce incidences of chronic disease, disability and premature death. With these additional reductions in cost-sharing, there’s never been a better time to schedule those important screenings.
DataPath, Inc. is the longest running solutions provider in the benefits administration industry. The company is also the creator of the award-winning employee education and engagement program, The Adventures of Captain Contributor.