Health Insurance Now Required To Provide Free Vaccinations

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There are many changes to health care that have come and are coming from the Affordable Care Act. For example, if you are a young adult looking for health insurance, you can now be covered under your parent’s plan (if it covers children) until you turn 26 years old. (See here for more info.)

Another change that I was reminded about from this CNN Money article is that plans must cover “recommended preventive services” without charging a deductible, copayment, or coinsurance. In other words, it’s free as long as you visit an in-network provider. Something to consider if you’ve been putting them off due to cost.

The list of included preventive services is long and covers a variety of screenings, and also includes the cost of 10 vaccines recommended by the Centers for Disease Control and Prevention. Here is the list from For adults, the CNN article highlighted the Influenza, Pneumococcal, Tetanus/Diphtheria/Pertussis, and Zoster (shingles) vaccines, but I see other familiar ones like Hepatitis A, so talk to your doctor. The required frequency varies from annually for the flu to once total for the shingles vaccine. A family member got shingles recently and it was not a pleasant experience.

There are some exemptions for existing plans, but as time progresses almost all plans should participate. From

Unless noted otherwise below, the recommended services must be provided without cost-sharing when delivered by an in-network provider in the plan years (in the individual market, policy years) that begin on or after September 23, 2010. For recommendations that have been in effect for less than one year, plans and issuers will have one year from the effective date to comply.

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  1. Is it really “free”? The rate that insurance premiums increase every year, seems like the cost is just passed on to the consumer. If many people on the plan do not use it, I think the insurance companies will actually make money off it.

  2. Glad you’re calling this out. No matter how you feel about the healthcare bill overall, this is one of its high notes.

    “An ounce of prevention is worth a pound of cure”…

  3. Your title is ambiguous. I read it as people are required to have health insurance before they can get (what used to be) free vaccinations. Got it, now, though. =)

  4. “There are some exemptions for existing plans” That means this does not apply to grandfathered plans i.e. plans that were in force before the legislation. Could someone please confirm? From your link, “The Departments of Health and Human Services (HHS), Labor, and Treasury issued interim final regulations on July 14, 2010 requiring new plans and issuers to cover certain preventive services without any cost-sharing for the enrollee when delivered by in-network providers. The interim final regulations do not apply to grandfathered plans and issuers. ” So its useless to most who had insurance before the legislation.

  5. Not useless, normally many companies negotiate with the insurance company about benefits and coverages every couple of years. Therefore eventually everyone will benefit from it.
    @ Jonathan I wouldn’t mind if you could highlight more about the new health care bill. There is a lot of good legislation in it for the consumer that I believe many people are not aware of.

  6. Sadly the big insurance companies gain the most from the new healthcare bill, even while they continue to shovel the concept that socialized medicine is bad. Hmmm…who profits from private healthcare? Look at the top 20 companies on Forbes list and you’ll see all the largest healthcare companies are represented and they made billions in profit. You don’t make billions in profit selling services/insurance unless you’re finding a way to deny people while taking their money for so-called coverage. Big healthcare will continue to fund the anti-socialized agenda (including PACS that funnel cash to legistlators) because they risk losing out on insane profits.

  7. @NM – Well, before insurance varied widely from plans with copays for everything, to gold-plated plans where you paid for nothing. Now preventative services are included for all. This does not solve the health insurance problem, but if everyone knows about it then hopefully it will improve health in general.

    @Mark – Sorry about that, I edited the title a bit 😉

    @KD – From the way I read it, they all have to comply soon enough, and may already have made the changes. I hate that you have to call your insurance company to figure out all the fine print as well, but they probably get asked rather regularly.

  8. Jonathan, please read

    then read definition of grandfathered plans. These plans will operate as before for many years to come. Plan participants in those plans do not get the benefit of preventative care.

  9. It does appear to be true that grandfathered plans can last a long time, but I don’t know if that will indeed be the case. They are not allowed to raise premiums if they stay grandfathered, nor cut any benefits. I think eventually they will fall into line. Also see this section

    “Protecting Patients’ Rights in All Plans

    All health plans – whether or not they are grandfathered plans – must provide certain benefits to their customers for plan years starting on or after September 23, 2010 including:

    No lifetime limits on coverage for all plans;
    No rescissions of coverage when people get sick and have previously made an unintentional mistake on their application;
    Extension of parents’ coverage to young adults under 26 years old; and the

    For the vast majority of Americans who get their health insurance through employers, additional benefits will be offered, irrespective of whether their plan is grandfathered, including:

    No coverage exclusions for children with pre-existing conditions; and
    No “restricted” annual limits (e.g., annual dollar-amount limits on coverage below standards to be set in future regulations).”

  10. Please read

    “They are not allowed to raise premiums if they stay grandfathered” is simply wrong.

    From my link, “Grandfathered health plans will be able to make routine changes to their policies and maintain their status. These routine changes include cost adjustments to keep pace with medical inflation, adding new benefits, making modest adjustments to existing benefits, voluntarily adopting new consumer protections under the new law, or making changes to comply with State or other Federal laws. Premium changes are not taken into account when determining whether or not a plan is grandfathered.”

    My link also gives an estimate of the percentage of plans that will continue to be grandfathered. The point I am making is that your claim of free preventative care being available to most in coming years is wrong. It may be available to few but certainly not most.

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