Jackson Hospital | Partners | SUMMER 2015

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WE ALL WANT to do what we can
to maintain good health. Of course, we
have budgets to balance too. So it’s good
to know that many important stay-well
services—like recommended immuniza-
tions, tests and checkups—are covered
under the Affordable Care Act (ACA) at
no extra cost to you.
That means you typically don’t have
to meet any co-pays, co-insurance or
deductibles when you get these services
from an in-network provider.
“My advice is for people to familiarize
themselves with the preventative section
in their insurance handbooks, as most
of these types of visits, such as wellness
visits, well-baby visits, etc., are covered
at 100 percent on an annual basis,” said
Beth Hataway, WellnessWorks corporate
health consultant for Jackson Hospital.
“Additionally, preventative tests like
mammograms and colonoscopies are
usually covered at 100 percent depend-
ing on eligibility. WellnessWorks really
encourages people to take advantage of
the wellness visit because staying healthy
helps keep them out of more costly
urgent care settings.”
The preventive services covered under
the ACA have earned either an “A” or “B”
rating from the U.S. Preventive Services
Task Force—meaning they’re likely to
provide either substantial or moderate
health benefits.
But whether a test or other type of
Preventive
care that’s
easy on the
wallet
Many screenings
are covered at
no cost under the
Affordable Care Act
Allowed amount. The most your
plan will pay for certain healthcare ser-
vices. If you’re charged more than your
insurance will pay, you may have to pay
the difference.
Co-pay. This is short for co-payment.
It’s a set dollar amount you pay each
time you see a provider, get a prescrip-
tion or use another covered health
service. Your co-pay can vary.
Co-insurance. The percentage of
the cost of a service that you must pay
UNDERSTANDING INSURANCE TERMS
after you’ve met your deductible. A
common co-insurance ratio is 80-20. In
other words, insurance pays 80 percent
of the allowed amount for the service
and you pay 20 percent.
Coverage. The health services your
plan will pay for.
Deductible. The amount you’re
required to pay for medical care each
year before your insurance pays.
Formulary. A list of prescription
drugs that your health plan or prescrip-
tion plan will cover. It’s also called a
drug list.
In-network/out-of-network.
Providers—hospitals, doctors, specialists
and therapists, for example—who
accept your health insurance are called
in-network providers. Ones that don’t
are called out-of-network providers. It
typically costs you more to see out-of-
network providers.
Premium. The set monthly amount
you pay for insurance.
preventive care is actually recommended
for you (or your family) depends on your
age, medical history, and whether you’re
a man or a woman. Your doctor can tell
you more.
Remember: This is just a sample of the
types of preventive healthcare services
covered under the ACA. You can read
about all of them at
Search for “Preventive Care.”
And it’s always a good idea to check
your health insurance plan for details
about coverage too.
A SAMPLING OF SCREENINGS
There are dozens of preventive services that may be covered for
adults and children. Some of them include:
Blood pressure screenings.
Breast, cervical and colorectal cancer screenings.
Diabetes screenings.
Screenings for sexually transmitted infections, including HIV.
Many types of vaccinations.
Well-woman checkups.
Many children’s screenings, including vision and hearing checks.
Abdominal aortic aneurysm screening.
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