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Health Law Targets Preventive Services For Women, But Also Offers Help For Men

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There are many recommendations for preventive care in the health law. Services recommended by the U.S. Preventive Services Task Force have to be provided without charging anything out of pocket.

An independent panel of medical experts currently recommends that women and men should be screened for high blood pressure, elevated cholesterol and blood sugar levels, and for colorectal cancer. It advises against routinely screening men for prostate cancer, however, noting that research hasn’t shown it reduces death from the disease (Medicare covers an annual prostate cancer test, but you may owe a copayment).

The drafters of the health law paid special attention to women’s preventive health needs, creating additional recommendations targeted specifically at them. This was done in part to address recognized gaps in women’s services, especially in the areas of sexual and reproductive health, said Adam Sonfield, senior policy manager at the Guttmacher Institute, a reproductive health research and policy organization.

Meanwhile, Medicare generally only covers genetic testing for the two BRCA mutations that are associated with an increased risk of breast and ovarian cancer if a person already has been diagnosed with cancer and have a family history that indicates testing is appropriate.

Throughout its history, the Medicare program, which provides health benefits for older and disabled Americans, has focused on treating injury and illness, not preventing them. Although the program now covers some cancer screening tests such as mammograms and colonoscopies, those changes were specifically authorized by Congress.

The U.S. Preventive Services Task Force recommends that women who have a family history of breast or ovarian cancers be screened to determine if they’re at higher risk for potentially harmful genetic mutations and, if appropriate, referred for genetic counseling and BRCA testing. Under the health law, private insurers are required to cover such testing without charging women for it. But that provision does not apply to Medicare.

For people with marketplace plans who travel, an insurer can’t require a person to pay more for care in an emergency department that’s not in his or her provider network than it would have mandated for emergency care in network.

But once patients leave the emergency department, they may get hit with out-of-network charges if they are admitted to the hospital, for example, or need other follow-up care and are far from home.

You have a few options. Individual Blue Cross Blue Shield plans that are sold on many marketplaces may offer access to BCBS providers nationwide and overseas.

Buying an accident policy might be an option. These plans typically pay a fixed dollar amount to offset your costs if you’re injured in an accident. But they can be tricky, because policies don’t cover pre-existing medical conditions, and the insurer might deny a claim that it considers related to an earlier medical problem.