Insurance plans must cover breast cancer preventive medications

Posted on January 9, 2014 | Comment (1)

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According to a set of FAQ’s issued by the Center for Consumer Information and Insurance Oversight (CCIIO), insurers are now required to fully cover medications that help reduce the incidence of breast cancer among women at high risk.  Examples of these medications include tamoxifen and raloxifene.  The policy change, arising from recommendations by the US Preventive Services Task Force (USPSTF), was decided in September 2013 and goes into effect for plan years beginning on or after September 24th, 2014.

Comment (1)

  • Annuities says:

    Keep a written log of every conversation you have with the insurance company, including the date, time and length of the conversation. This will ensure that you and the insurance company are both on the same page about what’s been said. Recording this information can also help you reach a settlement, in cases of mishandling by the insurance company.

The ACA requires all individual and non-grandfathered group health plans to cover certain preventive services, including contraceptive services. This is an update to the March 2012 brief on Contraception Coverage within Required Preventive Services, and to the April 2012 update to that brief.
Preventive services are optional for traditional Medicaid beneficiaries[1] ages 21 and older who are covered under the standard Medicaid program. Young adults ages 18-21 remain entitled to EPSDT benefits, which encompass periodic and as-needed health exams, all age-appropriate immunizations, and other preventive services.
On February 1, 2013, the Centers for Medicare & Medicaid Services’ (CMS’) Center for Medicaid and CHIP Services released a State Medicaid Director letter regarding implementation of section 1406 of the Affordable Care Act (ACA). Section 4106(b) establishes a one percentage point increase in the federal medical assistance percentage (FMAP), effective January 1, 2013, applied to expenditures for adult vaccines and clinical preventive services for states that cover, without cost-sharing, the full list of ACA preventive services. Specifically, the preventive services covered under the policy are those assigned a grade of A or B by the U.S. Preventive Services Task Force and the approved vaccines are those recommend by the Advisory Committee on Immunization Practices. For a complete list of the preventive services covered under the policy, click here and for a complete list of covered vaccines, click here.
The U.S. Department of Health and Human Services (HHS) has issued an amended version of the previous Interim Final Rule on the coverage of preventive services by group health plans and health insurance issuers under the Affordable Care Act (ACA). The amended rule reflects recent recommendations by the Institute of Medicine (IOM) regarding particular preventive services for women that should be covered at no cost by insurance companies. Services include screening and counseling for certain sexually transmitted infections, screening for gestational diabetes, and among others, counseling and contraception to prevent unintended pregnancies. The Internal Revenue Service has also issued an amended rule that reflects the coverage of these preventive services. *** On August 3, 2011, HHS issued an amendment to the amended IFR, further clarifying the expemption of religious organizations from the contraception coverage requirement. For more information on prevention, click here.
The Centers for Medicare and Medicaid Services has announced a final rule with comment period eliminating cost sharing for most preventive services and reduces other out-of-pocket costs.
The Commonwealth Fund recently published a paper in Medscape Public Health regarding preventive health services under the Affordable Care Act (ACA). The law has already extended coverage to dependents through age 26. By 2014, Medicaid will expand to cover most low-income adults and the exchanges will extend insurance to many small business and individuals. This eminent expansion of health insurance coverage will greatly increase in the use of preventive services in the United States. ACA provisions also eliminate cost sharing associated with the provision of preventive services, which will also likely impact use. Finally, the movement toward medical homes will also augment the use of preventive services. The paper discusses these relationships in the context of delivery system reforms.