Prevention: The Basics

Prevention: The Basics

What is Prevention & Why Promote it?

The ACA’s Preventive
Health Services Provision

Title IV of the ACA, “Prevention of Chronic Disease and Improving Public Health” promotes prevention, wellness and public health, and supports health promotion efforts at the local, state and federal levels. Title IV mandates that both fully-insured and self-funded health plans, including those available through the Health Insurance Marketplace, cover a set of evidence-based preventive services for all adults, with special provisions for women and children.

A self-funded employer or health plan must provide first-dollar coverage for the following:

View a complete list of covered services for all adults, women and children.

The Issues & Barriers

Employees:

Through the ACA mandate, millions of Americans became eligible for preventive health services without cost sharing. However, according to a recent Kaiser Health Tracking Poll, fewer than half of surveyed consumers were aware of this benefit. Many people have the misconception that they will have to pay out-of-pocket costs to access preventive care, so they avoid seeking the services.4



This is a significant barrier to getting important preventive care.

Employers:

Surprisingly, some employers were either unaware of the free preventive services required by the ACA or never made modifications to the company’s plan design and language after the ACA mandate was implemented. To improve access and utilization, employers need to:

  • Review claims data, participation in preventive services and current benefit plan design language to identify gaps or issues that are impacting low utilization which could lead to cost and access barriers
  • Determine if existing communication strategies and vehicles are sufficient to address key issues
  • Identifying and closing related gaps in benefit plan design
  • Focus key messages on the importance of prevention in maintaining good health and finding and treating health problems early, before they become more serious and expensive to treat+
  • Take advantage of opportunities throughout the year to promote prevention and provide reminders about no-cost sharing
  • Consider linking preventive benefits messaging to an existing wellness program or initiative