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3 groups that fall through preventive care coverage cracks


Despite coverage expansion under healthcare reform, 30 million people will likely remain uninsured and miss out on preventive care and wellness services--such as cancer screenings, check-ups and contraceptives--that health plans are required to cover at no cost to the patient.

As a result, several groups of individuals who need access to preventive services may fall through the cracks, Kaiser Health News reported, including:

1. In states that chose to forgo Medicaid expansion, adults with incomes below the federal poverty level ($11,490 in 2013) won't be eligible for subsidies on the health insurance exchanges and will likely remain uninsured.

2. People who are exempt from the individual mandate, including individuals who cannot afford coverage, taxpayers with income below the filing threshold, members of religious sects and people who are incarcerated, will have no guaranteed access to preventive services, KHN noted.

3. Immigrants who are in the country illegally can't buy coverage on the exchanges and low-income legal immigrants who must wait five years for Medicaid eligibility and may not be able to afford coverage in the meantime will also fall through the cracks, according to the article.

Even with the Affordable Care Act requiring new health plans to cover most preventive care without coinsurance, practices still struggle to bill patients appropriately, FiercePracticeManagement previously reported. Doctors' offices still don't know what they need to bill for and what they don't.

With such confusion surrounding preventive care, insurers like Horizon Blue Cross Blue Shield of New Jersey are partnering with doctors in patient-centered medical home programs that boost preventive and wellness care, FierceHealthPayer previously reported.

For more:
- here's the KHN article

Related Articles:
Physicians grappling with mixed messages about preventive care
A state-by-state look at uninsured rates under healthcare reform
Horizon medical home lowers costs, boosts preventive care
Preventive care coverage causing confusion for physicians, insurers