Health plans must cover preventive care services in full

It’s always wise to question your health plan if it denies coverage for your care or covers less than you expected. Improper denials or inadequate coverage appear all too common. The latest evidence comes after a report by the National Woman’s Law Center finding that health plans had been refusing to cover all types of women’s contraceptives in full in violation of the Affordable Care Act. Last week, the Department of Health and Human Services made clear that health plans must cover preventive care services in full.

Health plans cannot pick and choose among the preventive care contraceptive services they cover. They must cover the full range of FDA-approved contraceptive services. They must also cover well-woman visits at no charge to the patient.

The National Woman’s Law Center surveyed 100 insurance companies in seven states and found that 15 health plans failed to cover all forms of FDA-approved birth control, including Cigna, Aetna and Anthem Blue Cross Blue Shield. The Kaiser Family Foundation conducted a similar study of 20 insurers in five states and found, among other things, that some insurers do not cover birth control patches, four insurers did not cover the contraceptive implant Implanon, and one insurer did not cover the NuvaRing.

The Department of Health and Human Services clarified that the health plans must offer for free at least one of the 18 contraceptive drugs available, but they can cover the generic drug in full and charge a copay for the brand name drug. The ruling will take effect in January 2016.

For answers to a range of questions on the Affordable Care Act, visit the Center for Consumer Information and Insurance Oversight. And, remember, if your health plan denies coverage, fight back.  Here’s how.