IOM Tells Plans To Cover 8 Health Services for Free

Health insurers have to cover eight preventive health care services at no cost under the Affordable Care Act, and they are not thrilled, according to the plans’ lobbying group. “Broadening the scope of mandated preventive services that go beyond or conflict with the current evidence-based guidelines will increase the cost of coverage for individuals, families, and employers,” says Robert Zirkelbach, a spokesman for the advocacy group America’s Health Insurance Plans. He warns that there could be a corresponding increase in costs.

The Institute of Medicine (IOM) identified diseases and conditions that are more common or more serious in women than in men or for which women experience different outcomes or benefit from different interventions. The IOM report suggested full coverage for the following additional services:

  • Screening for gestational diabetes
  • Human papillomavirus (HPV) testing as part of cervical cancer screening for women over age 30
  • Counseling on sexually transmitted infections
  • Counseling and screening for HIV
  • Reproductive health counseling, including contraception education and prevention of unintended pregnancies
  • Lactation counseling and equipment to promote breast feeding
  • Screening and counseling to detect and prevent domestic and other interpersonal violence
  • Yearly well-woman preventive care visits to obtain recommended preventive services

Linda Rosenstock, dean of the School of Public Health at the University of California-Los Angeles, is the chairwoman of the IOM’s committee of experts that made the recommendation in a report titled “Clinical Preventive Services for Women: Closing the Gaps.” Rosenstock says that the eight services “are necessary to support women’s optimal health and well-being. Each recommendation stands on a foundation of evidence supporting its effectiveness.”

Insurers contend that they are already covering preventive services based on evidence-based guidelines from independent third-party groups. “Health plans have prioritized prevention and encourage patients to get recommended preventive care,” says Zirkelbach. “Current coverage of preventive services is based on the recommendations put forth by independent, expert organizations such as the Advisory Committee on Immunization Practices (ACIP) and the U.S. Preventive Services Task Force (USPTF).”

The report, however, says current guidelines on preventive services contain gaps when it comes to women’s needs. Because they need to use more preventive care than men on average. Women also face higher out-of-pocket costs, the report says.

MANAGED CARE August 2011. ©MediMedia USA