The primary benefits of a health plan should cover a wide range of essential health services, including prescription drugs, preventative and wellness services, and chronic disease management. Some health insurance coverage can be based on on age, income level, or disability status. According to resources like IEHP you should check to see what you are qualified for to help you with some of the coverage listed below and possibly more.
If you do not have health insurance, you may have to pay the total price for many of the prescription drugs your doctor recommends. The problem with this is that not all health insurance plans cover all prescription drugs. Instead, each plan has a list of drugs that it covers. Sometimes, prescription drugs are automatically covered if you receive a doctor’s prescription. However, there are other cases when you might have to pay the total cost of the drug. In addition, you should be aware that the list of drugs covered by your health insurance plan may change over time, especially if you switch prescription drugs or start a new medication.
While the federal government has not made it mandatory for insurance providers to provide prescription drug coverage, many states have implemented regulations requiring them to include these drugs’ coverage in their plans. The new rules also require all projects to include at least one medication per drug class. Otherwise, consumers could face considerable out-of-pocket costs, making it difficult to choose a health plan.
Preventative and wellness services
Health insurance coverage for preventative and wellness services is essential to any health plan. They include screenings and immunizations to prevent common diseases, behavioral interventions to manage chronic conditions, and counseling to promote healthy living. The Affordable Care Act mandates that all plans provide these benefits at no cost to their members. Some plans even provide incentives for enrolling in these programs. For example, a carrier might offer gift cards to enrollees who lose five to 10 pounds and undergo biometric screening.
In addition to routine preventative care, preventative and wellness services include screening for cervical cancer and contraception. Although the Affordable Care Act requires insurers to cover these services, the House’s proposed legislation could impact the provision of free preventative services in primary health insurance plans.
Chronic disease management
Chronic disease management is managing and preventing disease by working with a lead physician to maintain health and wellness. It requires regular follow-up appointments and is particularly important for people with chronic illnesses. The process includes educating patients about their condition and gathering social history. Patients who understand their disease are more likely to comply with prescribed regimens and receive high-quality care. Including social and community health workers as part of the integrated care team is also essential. These workers are exceptionally knowledgeable about the social determinants of a person’s health and can help patients learn how to manage their conditions better.
According to a study of poor children living below the federal poverty level, children who do not receive adequate health care are at a higher risk of developing chronic conditions. These conditions require regular monitoring and can lead to hospitalization. Therefore, chronic disease management is essential for improving health outcomes for the poor and containing costs in the health care system.
The Affordable Care Act includes a mandate that insurers cover preventive services. These services include immunizations, screening for common diseases, behavioral interventions to control chronic conditions, and counseling on healthy living. Prevention is one of the most critical aspects of health care and has broad bipartisan support. The Obama administration has taken steps to expand access to these services through its Let’s Move! Campaign and the Recovery Act. These efforts are laying the foundation for overhauling our healthcare system.
Preventative care has the potential to save hundreds of thousands of lives each year. It has been estimated that it can prevent up to nine out of 10 leading causes of death. Yet cost is one of the main barriers to prevention, keeping many people from getting the care they need. Fortunately, the Affordable Care Act requires most health insurance plans to cover certain preventative care services without a deductible or copay.