Dear Tom and Alan: I just read that House Minority Leader Nancy Pelosi spoke at the Commonwealth Club and referred to “free” preventive care services under the Affordable Care Act. Free? — Doubting Thomas
Tom: Great name, Thomas. Yes, specifically for women, the Institute of Medicine has expanded the required health plan coverage guidelines to include a number of procedures with no charge for copayment, coinsurance, or deductible when the services are provided by a network provider. Here are the details from the Health Resources and Services Administration website:
1. Annual well woman preventive care for services that are “… age and developmentally appropriate, including preconception and prenatal care.”
2. Annual counseling for sexually transmitted infections and for human immune-deficiency virus.
3. Annual screening and counseling for interpersonal and domestic violence.
Al: For other than annual services:
1. Human papillomavirus testing with screening to begin at age 30 to continue every
2. Contraception and sterilization procedures.
3. Breastfeeding support, supplies and counseling.
4. Screening for gestational diabetes.
Tom: The question for which we don’t have an answer is what about lab work and additional tests outside of the provider’s office?
Al: We’ll begin to get that answered after
Aug. 1, when all plans are required to offer the above.
Dear Tom and Alan: I’m over 65, on Medicare with a supplement, and am having a heck of time finding dental and vision coverage in one package. Everybody I ask says the best is through an employer group, but I’m not employed! What to do? — Old School
Tom: What people are telling you is generally true, School — the larger the group, the more spread out the risk. If it’s a large group with old and young it can be even better because some of the group will never use the services and that will help both the rates and the thoroughness of the plan. But since that is not at all helpful in your particular case, here are two recommendations:
Al: If your Medicare supplement happens to be Health Net, they offer their subscribers a Standard PPO Dental and Vision plan for $27 per month, and an Enhanced PPO Dental and Vision plan for $41 per month. A Preferred Provider Organization (PPO) usually means you have a number of providers to go to rather than just one “gatekeeper” that you have to go through.
Tom: Blue Shield also offers a “Specialty Duo” dental, plus vision, plan specifically for their Medicare supplement members at $57.50 per month. It’s also available for subscriber, plus spouse/domestic partner, at $115.00 per month. By the way, Blue Shield has a “Specialty Duo” stand alone plan for all ages. For example, a family costs $181.70, and includes orthodontia after 12 months.
Submit your questions or reach the Health Insurance Guys at Schrette Insurance, 1556 First St., Suite 105, Napa, CA 94559; 255-9511; firstname.lastname@example.org or email@example.com.