The Health Shopper

What’s next in health care reform? Women.

As of next summer, when new reform provisions kick in, regular checkups and tests along with some forms of birth control will be more widely accessible to women. Annual well-woman visits, diabetes screenings, all contraception, and support for breast-feeding mothers will be covered under most health insurance plans, with no co-insurance, deductibles or co-pays for those services. This change is intended to increase overall wellness among women and decrease the numbers of abortions and unwanted pregnancies by improving the quality of women’s health care.

The new reform provisions also place emphasis on preventive care services, including HPV and HIV screenings, contraceptive patient counseling, gestational diabetes screenings, and domestic violence counseling.

More and more, families are looking to public health insurance options for their children’s coverage thanks to greater access to public plans and job losses, according to a recent study by the University of New Hampshire. This seems to be particularly true for more rural as well as inner-city areas where overall coverage rates have generally been lower than suburban areas.

According to the researchers, unemployment is the key factor in the trend. With unemployment, employer-provided coverage is usually terminated and due to the drop in income families and individuals often become newly qualified for public plans. Eligibility for health insurance plans has also been expanded, which helps push families and individuals in making the choice to go to public insurance. The research also uncovered an unfortunate situation: nationwide, about 9 percent of children do not have any type of coverage; over half of them are eligible for coverage through Medicaid and/or SCHIP.

“Research demonstrates that most of these eligible children come from states with low participation rates and are disproportionately Hispanic. Because those who have health insurance are healthier overall and, more importantly, because healthy children are more likely to become healthy adults, focusing on covering eligible children should remain at the forefront of the nation’s agenda,” the researchers said.

On the whole prescription drug prices have been steady for some time and are projected to remain so through 2012. According to HHS, approximately 900,000 beneficiaries are currently receiving discounts of up to 50 percent on brand-name drugs through Medicare and have seen greater accessibility in generics.

But a recent study from NERA Economic Consulting reveals that seniors, particularly those on specialty tiers in their health plan, are currently “largely unaware” of the often-exorbitant costs of prescription drugs. “Specialty tiers”, as defined by NERA, are separate prescription categories that include “higher-cost, brand name medications… used to treat conditions like cancer, multiple sclerosis, rheumatoid arthritis, HIV/AIDS and lupus”.

The results of the study showed that Medicare consumers were not aware of Medicare Part D plans’ differences in prices of medicines for more serious recurring issues. They also misjudged the out-of-pocket costs for specialty-tier medications and thought they would be paying a co-pay (as opposed to coinsurance) for a prescription drug on the specialty tier. Overall, Medicare beneficiaries underestimated the prices of prescription drugs but, even worse, were not certain how much they were paying for each drug.

Medicare beneficiaries should consult with doctors and speak with Medicare or the provider directly before opting to use (and pay for) any prescription drugs.

As of Jan. 1, a variety of preventive screenings and services have been fully covered under Medicare. However, beneficiaries may not be fully aware of the new preventive services offered. The Centers for Medicare and Medicaid Services (CMS) has acknowledged that public awareness of the benefits needs to be increased, and that more needs to be done despite continuing efforts.
According to CMS, over 50 percent of Medicare beneficiaries utilized the new preventive screenings, but very few of the Medicare recipients have taken advantage of the Annual Wellness Visit, which includes consultations with health care providers to go over medical history, genetic inclinations, prescriptions, risk factors, choices for treatment, and to create screening schedules and take basic measurements.
Some of the free screenings include:

• Annual mammogram
• Annual prostate cancer screening
• Annual diabetes screening, twice a year for prediabetic patients
• Colonoscopy every 10 years, every 2 years for high risk patients
• Bone mass measurement every 2 years

After a year in action, there are mixed feelings on health care reform today.