Preventive Services Covered by Private Health Plans Under the Affordable Care Act (ACA)

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This report details the requirements in the Affordable Care Act (ACA) that private insurers (including self-funded employers) – with the exception of so-called “grandfathered” plans – cover certain preventive services without any patient cost sharing.  For wellness professionals, this report also provides clarity on how rich and costly these ACA-mandated preventive benefits are.  With proper preventive care, health problems can often be identified earlier, managed more effectively, and treated before they develop into more complicated, debilitating illness. Research has shown that evidence-based preventive services can in many cases save lives, and that some services are also cost-effective. Despite long-standing recommendations for use of evidence-based preventive services for a wide range of health conditions, actual utilization varies substantially.  While a number of factors contribute to use of  preventive services, out of-pocket costs in the form of copayments and deductibles can act as a barrier, keeping even the insured from seeking recommended screenings, counseling, and immunizations. Published: 2011

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