Flu shots should be free after health reform
Advertisements for
I've been writing about health care reform -- and trying to put it in the simplest layman's terms for our readers -- since the Affordable Care Act (ACA), better known as Obamacare, took effect in
"Insurers must cover A- and B-level preventive services, such as screenings and immunizations recommended by the
In other words, flu shots, annual physicals and annual screenings, including physicals with your family doctors, mammograms, Pap smears and colonoscopies, are supposed to be "free" with no copays or other costs for people with ACA-compliant insurance plans. And by now, pretty much all of us who are insured have compliant policies, whether through employer group plans or individual polices bought off or on healthcare.gov.
Just last week, I was ranting about the soaring costs of health insurance premiums and deductibles with a sorority sister who noted her company's group plan, once grandfathered in under pre-ACA laws, now must meet the new government standards that have resulted in higher monthly premiums.
"Grandfather died," she said. Funny.
What's not funny is the onus is on us consumers/patients to make sure we get the benefits promised in today's regulatory environment.
Case in point is what turned into a quest for my flu shot and that of my 15-year-old daughter, Jess.
Though our shared internist practices only two miles down the road, I didn't schedule the vaccinations through his clinic, thinking I'd avoid the hassle (ha!) and possibly being charged for doctors' office visits, when we simply needed to swing by somewhere and get our, um, quickie flu shots. So after picking up Jess after school last Wednesday, I drove directly to Walgreens where we regularly get our prescriptions filled. After some 15 minutes, and help from two pharmacy staffers, I was told Walgreens wasn't contracted by our insurance plan to administer the shots.
The next morning, I called
That gal wanted to refer me to the closest Walgreens until I told her about the previous night's fiasco. After a brief hold, she referred me to a nearby
So, Thursday night, I whisk Jess to CVS, where we stand -- and sit -- for more than 45 minutes. The staff inputted our information and got our injections ready. We signed the waivers and we were all set, until I noticed a
The intern/
Overcoming glitch
After another call to LDI late Friday, we returned to CVS on Saturday to get our flu shots. A glitch in the system initially blocked the zero copay for a quadrivalent flu shot with added protection, a customer service rep explained on a message on my voicemail.
Back in the car on Thursday night, Jess made fun of how many times I mentioned Obamacare. I told her that I hoped I'd modeled good consumerism for her; that she should never pay
My parental lesson coincided with Jess wanting to cash in coins from my piggy banks for a trip to the mall on Friday. The kiosk at Walmart charged a 10.9% fee for cash, which I refused to pay, explaining to her that it would be throwing away hard-earned money, about
We settled instead for a no-fee gift certificate to Chili's, where we directly drove for dinner. Jess had macaroni and cheese and a pink lemonade, and I had fajitas and a well-deserved margarita.
Obamacare at a glance
Oklahomans can find assistance at: Localhelp.healthcare.gov or at 800-318-2596.
Enrollment opens
Consumers whose annual household incomes are between 100% and 400% of federal poverty (roughly
The rates for the various ACA-compliant plans are the same whether they're bought through the exchange or directly from an insurance company. The only thing the exchange provides is access to potential premium subsidies.
Employers of 50 or more full-time equivalent must offer affordable, quality health insurance to workers who average 30 or more hours a week, or face annual penalties of
Insurers can't deny coverage based on pre-existing conditions, and may not impose lifetime coverage limits.
Insurers must cover A- and B-level preventive services, such as screenings and immunizations recommended by the
Children who don't receive health care coverage from employers can stay on their parents' plans to age 26, regardless of marital or student status.
An 80/20 loss-ratio rule requires health insurers to spend no more than 20% of customer premiums on administration, or issue rebates to consumers.
Technically the requirement for individuals to have health insurance coverage still exist, but the penalty was lowered to
SOURCE:
___
(c)2019 The Oklahoman
Visit The Oklahoman at www.newsok.com
Distributed by Tribune Content Agency, LLC.
Is California Ignoring The Science On Wildfire-Prone Housing?
Breast Cancer Diagnosis A Special Challenge For Low-Income Patients
Advisor News
Annuity News
Health/Employee Benefits News
Life Insurance News