Your Healthcare Guide

How to Make the Most of Your Health Insurance

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If you're a regular reader of Health, then you already know that prevention is essential to good health—not just eating right and exercising, but staying on top of checkups and screenings to stop illness before it starts. The Affordable Care Act (ACA) aims to make that easier, by obligating most insurers to cover a wide range of preventive health services at no cost to you. (Not insured? Starting in 2014, the ACA will require everyone to have health insurance or pay a fee.) "Ideally you will look at your doctor as your partner in wellness rather than someone who treats disease," says integrative medicine specialist Robin Miller, MD, co-author of The Smart Woman's Guide to Midlife and Beyond. Learn what you've got coming with this helpful guide.

1. Lots of preventive care is now free...

Under the ACA, you won't pay out-of-pocket costs or deductibles for many preventive-care visits, screenings and tests, including annual well-woman visits, contraception and regular mammograms. (For the full list, visit healthcare.gov/prevention.) Most plans, including those in the new health-insurance marketplaces, must offer 100 percent coverage if you use an in-network provider.

2. ...but you'll need to read the fine print.

Not every service is covered for everyone; some (like screenings for colorectal cancer) are only for those in a particular age or high-risk group. Also, in certain cases, the details of what's included are left to the discretion of the insurer, so it's key to check your plan. For example, if your doctor recommends another screening after your mammo, you may have to fork over a co-pay or coinsurance for the follow-up. And while all methods of birth control are covered, your particular brand might not be.

3. Your plan may be different.

Some of the ACA's rules don't apply to insurance plans that existed before March 23, 2010. Those plans are grandfathered, and if they don't make significant changes, they don't have to provide all the ACA benefits, including offering preventive care for free. According to the Kaiser Family Foundation, 36 percent of people who are insured through their work are in a grandfathered plan as of 2013. If that applies to you (and even if you just started a job, it could), the informational materials should clearly state that it is a grandfathered plan.