Reducing Out-of-Pocket Expenses for Women and Children’s Preventive Care

woman preventive care

New preventive care and screening guidelines aimed at reducing out-of-pocket expenses for women, infants, children, and adolescents were recently announced by the Health Resources and Services Administration (HRSA) of the U.S. Dept. of Health and Human Services (HHS) The new guidelines take effect for plans starting in 2023.

Under the Affordable Care Act (ACA), certain group health plans and insurance issuers must provide coverage for preventive health services with no out-of-pocket costs. As a result, more than 150 million people with private insurance, including 58 million women and 37 million children, currently receive preventive services with no cost-sharing.

Women’s Preventive Care Guidelines Have Been Updated

The Health Resources and Services Administration issues Women’s Preventive Services Guidelines to help healthcare providers recommend routine services to their patients. In December 2021, those guidelines were updated to include:

  • Counseling for reduction/prevention of obesity for women in the 40-60 year range
  • Counseling for sexually transmitted infections (STIs)
  • Screening for immunodeficiency virus (HIV)
  • Well-woman preventive care visits
  • Access to contraceptives and related counseling
  • Breastfeeding supplies and services including double electric breast pumps

Children’s Preventive Care Guidelines Have Also Been Updated

The Bright Futures Program provides evidence-informed, age-specific guidelines to increase the quality of primary and preventive care for infants, children and adolescents. These guidelines were also updated to include:

  • Hepatitis B virus infection risk assessments from birth to 21 years
  • Cardiac arrest or death risks assessments for those aged 11-21
  • Behavioral, social and emotional screening
  • Universal suicide risk screening for those aged 12-21 years

Not All Cost-Sharing Was Eliminated

These new guidelines provide a lot of cost-sharing relief measures, but there are still some preventive care products and services that have additional costs. That’s where consumer-directed healthcare accounts can help.

Savings Accounts

Flexible Spending Accounts (FSAs) and Health Saving Accounts (HSAs) are tax-advantaged accounts used to offset out-of-pocket medical expenses, for products and services not covered in full by health insurance plans. Some examples of eligible preventive care products and services include:

  • Annual physical exams
  • Dental checkups
  • Eye exams
  • Co-pays, co-insurance and deductibles
  • Diagnostic devices like blood pressure monitors
  • Vaccinations

Health Reimbursement Arrangements

A Health Reimbursement Arrangement is an account used to pay for out-of-pocket medical expenses. It differs from FSAs and HSAs in that the sponsoring employer funds the plan and choses eligible expenses. There are four different types of HRAs (standard HRAs, ICHRAs, EBHRAs, and QSEHRAs) for different employment situations and may have different eligible items.

The Centers for Disease Control and Prevention found that preventive care, coupled with lifestyle changes, may reduce incidences of chronic disease, disability and premature death. These cost-sharing reductions and benefit account options, make this a great time to schedule important healthcare screenings.

DataPath, Inc. is the longest running solutions provider in the benefits administration industry. The company is also the creator of the award-winning employee education and engagement program, The Adventures of Captain Contributor.