• Home
  • preventative services

Tag: preventative services

My employer offers a health plan that covers preventive services and some other benefits, but it doesn’t cover inpatient hospital care (or only pays $100 per day for hospitalization). Because I’m offered this policy, does that mean I can’t qualify for subsidized coverage through the Marketplace?

The standard for “minimum value” has been clarified to also require plans to provide substantial coverage for hospitalization and for physician care.  The plan your employer offers would not meet this standard.  If that is the only plan your employer offers to you, then you would be eligible to apply for Marketplace coverage with premium tax credits.  However, if this so-called skinny plan is only one option offered to you, and if other plan choices offered to you by your employer do meet the “minimum value” standard and the affordability standard, then you would not be eligible for premium tax credits through the Marketplace.

I heard that plans have to cover preventive services without cost sharing. Does this include every preventive service and are there any limits to what is covered?

Your plan is required to cover a wide range of preventive services and may not impose cost-sharing charges (such as copayments, deductibles, or co-insurance) If you are enrolled in an ACA-compliant, non-grandfathered plan, including plans offered through the Marketplace.  The ACA requires private plans to provide coverage for services under four broad categories: evidence-based screenings and counseling, routine immunizations, childhood preventive services, and preventive services for women. So long as the preventive service is performed by an in-network provider, is not billed separately from the office visit, and is the main reason for the office visit, then the visit and the preventive service will be covered by the insurer without cost-sharing.

If you buy coverage on your own and you first purchased your policy prior to March 23, 2010, it may be a grandfathered plan. These plans are not required to cover preventive services without cost sharing. If you are not sure if your plan is grandfathered, check with your employer or your insurance plan.

In addition, short-term health insurance policies do not have to provide benefits required by the ACA and may not cover preventive services.

Get In Touch

Connect With Us

Hummingbird Insurance ♡ protecting what we love 

Insurance for individuals, families and employers. We specialize in employee benefits, Medicare, health, dental, vision, life & disability.

Hummingbird Insurance is an independent authorized agency licensed to sell and promote products from Blue Cross and Blue Shield of North Carolina (BCBSNC). The content contained in this site is maintained by Hummingbird Insurance. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. ®, SM  Registered marks of the Blue Cross and Blue Shield Association.
Products from Blue Cross and Blue Shield of North Carolina® (BCBSNC) are only available to North Carolina residents and employers.

Privacy Notice Statement | Copyright © 2018 | Hummingbird Insurance