One plus for patients in the federal health care reform law: You get basic preventive care for free. So, how can you make sure you're getting the care you need, with no cost sharing?
Patients need to be proactive and work with their doctors to get recommended screenings, vaccinations and procedures, experts say.
6 tips to get the right preventive care
1. Get a regular primary care physician.
Establishing a good relationship with a doctor makes it easier to get the care you need because the doctor knows you well, says Dr. Michael Gill, an internist at Loyola University Health System in Chicago. For example, a doctor who has a detailed grasp of your family history -- and possibly has even treated other family members -- might be more likely to spot the potential for problems.
"The doctor might say, 'OK, your dad had prostate cancer at age 50, so you ought to get screened earlier,'" Gill says.
2. Get informed.
Patients can be proactive by doing research on reputable health websites and talking to their doctors about what preventive care they might need, Gill says. One place to start: HealthCare.gov offers a basic overview of free preventive care services recommended for adults, such as blood pressure screening and basic vaccinations. The site also lists additional preventive care that should be covered for women, such as mammograms every one to two years for women over 40.
But don't rely on the Internet. "If you want the Internet to be your doctor for you, that's not good," says Dr. Joseph Pinzone, medical director of AMAI, a medical and wellness practice in Santa Monica, Calif. He adds that patients should print information and take it to their appointment.
3. Spend time with your doctor.
Just having a doctor isn't enough: You need face time, Pinzone says, adding that you should have a conversation with your doctor about which screenings and other preventive care you should receive.
One way to find a doctor who will spend time with you is to call several doctors' offices and ask about the typical length of appointments for new patients. "You might get 15 minutes; you might get a half hour, you might get more," says Dr. Marc Rabinowitz, founder of Prevention First personalized health care practice in Pennsylvania. Another option is to find a concierge medical practice like the one run by Rabinowitz, where patients typically pay a monthly subscription fee to get more personalized care, Rabinowitz says.
The cost? According to ConciergeMedicineMD.com, a subscription to a concierge medical service usually costs about $150 a month.
4. Don't put off tests.
If you're dreading a test or procedure that you think could be unpleasant -- for example, a colonoscopy, an age-appropriate screening test recommended starting at 50 -- you're probably not alone. A study in the New England Journal of Medicine showed that only about 50 percent of patients who are told about age-appropriate screening tests actually follow through, Rabinowitz says. "There are certain tests people will just avoid," he says, adding that doctors need to explain the importance of necessary tests -- and patients need to do their part, too.
5. Check on insurance coverage.
One important caveat: The Affordable Care Act only requires insurers to cover preventive care without cost sharing from in-network providers. So, check to make sure your doctor and other providers -- such as the laboratory where blood or other tests will be performed -- are in your insurer's network, says Cigna's chief nursing officer, Susan Gaca.
If you need a screening due to individual risk factors, such as family history or other health conditions, a doctor typically would use a different code when billing your insurance company, Gill says. That’s important because the ACA requires preventive care without cost sharing – and, in some cases, you may only be able to get these tests covered by your insurer if you’re considered at higher risk for the condition.
For example, if a 40-year-old with no symptoms asked for a colonoscopy for peace of mind, they’d probably have to pay out of pocket, Gill says. However, if the patient’s parent got colon cancer at a young age, the test would likely be fully covered. If you have any doubt about whether a test or procedure will be covered with no cost sharing, talk to your doctor and your insurer.
6. Get follow-up care if needed.
Patients who walk out of a doctor's office with a diagnosis also should know the plan of action and how it will be carried out, Pinzone says. In some cases, a doctor can do something about a problem immediately, such as removing polyps during a colonoscopy, Pinzone says.
But in most cases, a problem caught during preventive care screenings will need regular follow-up and care. For example, patients who are obese might need follow-up sessions with a dietician and a psychologist. "You really need the resources to back