wellness and preventive care :: Article CreatorSupreme Court Upholds Key Obamacare Measure On Preventive Care
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The Supreme Court on Friday upheld a key provision of the Affordable Care Act, ensuring, at least for now, that some 150 million people will continue getting many free, preventive services under the act.
The vote was 6-3, with Chief Justice John Roberts, and Justices Amy Coney Barrett and Brett Kavanaugh joining the court's three liberal justices in the majority.
Siding with the government on Friday, the court upheld the Affordable Care Act, allowing the U.S. Preventive Services Task Force to continue determining which services will be available free of cost to Americans covered by the Affordable Care Act.
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At issue in the case was a lawsuit that sought to undo the preventive care provision by challenging the appointment process for members of a 16-person task force that determines which preventive services are to be provided for free under insurance policies. Two lower courts found that the appointments were unconstitutional, but on Friday, the Supreme Court disagreed.
More Supreme Court decisions from today:
More Supreme Court decisions today:
Supreme Court limits nationwide injunctions in birthright citizenship order SCOTUS: Parents can opt kids out of classes with LGBTQ book characters Supreme Court sides with Texas' age verification law for porn sites Supreme Court postpones Louisiana redistricting case to next term Supreme Court upholds program providing internet access to rural Americans Writing for the court majority, Justice Kavanaugh said the Department of Health and Human Services has the power to appoint members of the task force.
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"Task Force members are supervised and directed by the Secretary, who in turn answers to the President, preserving the chain of command in Article II," Kavanaugh wrote.
The ACA's preventive treatments have benefited millions of people since the health care law went into effect 11 years ago — a sufficiently long time for most people to take the free coverage for granted. Activists argued that if the court ruled for the groups challenging the law, the benefits could disappear.
Friday's case arose when the preventive care task force classified pre-exposure prophylaxis (PrEP) drugs as essential to preventing HIV. Preventive PrEP coverage under the ACA includes not only HIV testing and medication, but also clinic visits and lab testing without added cost-sharing. Without ACA coverage, PrEP care would be astronomically expensive for most Americans.
The suit was brought by individuals and businesses with religious objections to the PrEP mandate—they claimed that providing PrEP coverage encourages "sexual behaviors and drug use" antithetical to their Christian beliefs.
Braidwood Management, the case's named plaintiff, is led by Republican mega donor Steven Hotze who has referred to members of the LGBTQ+ community at different times as "morally degenerate," "satanic," and "termites." Hotze, has challenged the ACA in at least two other federal lawsuits.
The court's decision on preventive care likely will protect other existing preventive services under ACA, including treatment for blood pressure screenings, as well as birth control, breast and lung cancer screenings, immunizations, and more.
Prior to the court's decision on Friday, proponents of the ACA's existing preventive coverage had worried that without it, the financial burden of out-of-pocket expenses for these services would have discouraged people from getting care to prevent or detect disease at an early and treatable stage.
"I cannot think of another health policy that impacts more Americans than the preventive services provision," said Dr. Mark Fendrick, a professor of medicine and public health at the University of Michigan.
Two lower courts in Texas found that the government violated the Appointments Clause of the Constitution because its task force members were appointed not by the president, but by the secretary of Health & Human Services.
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The Supreme Court, however, disagreed, declaring that the task force was not composed of principal officers who must be appointed by the president and confirmed by the Senate. Rather, the court said, the advisory panel is composed of "inferior officers," who may be appointed by a department head if that power is designated by Congress. Moreover, as the government pointed out in its briefs, the task force members are directly supervised by the HHS secretary, and members can be terminated at will.
Check Your Health- Mid-Year Check-in With Your Health Plan
Your health insurance plan is an investment in your health and well-being, providing you with the financial support needed for both unexpected and expected medical care and prescription coverage.
A common misconception when it comes to health plans, however, is that it's only for medical emergencies or when you're feeling unwell.
"Your health insurance isn't just for emergencies—it's a toolkit," said Alex Hargrove, Senior Account Manager of Individual Products at Select Health. "When you use it regularly, you get more value, more support, and better long-term health outcomes."
It's the middle of the year, and Select Health has three recommended healthcare and health insurance steps you should take if you have not already.
1.Schedule an appointment with your healthcare provider and focus on preventive care services.
Even if you are in good health, it's still important to routinely see your healthcare provider. According to the Centers for Disease Control and Prevention, preventive care could save over 100,000 lives in the United States each year. Most healthy adults don't need to see their provider every year. However, doctor visits are dependent on your current health status, and your provider can recommend how often you should be scheduling appointments. Make sure you don't disregard the benefits of seeing your provider routinely.
Similarly, staying on top of preventive care services is an important factor when focusing on your health. Most health plans cover preventive care services, so you don't have to worry about costs like copays and out-of-pocket expenses. Both adults and children have a set of recommended care services. To learn more about the specific care services for you, ask your healthcare provider or health insurer for a breakdown of these services.
Typical healthcare services include cholesterol tests and some cancer screenings for adults, well-baby or well-child visits, autism, depression, and developmental screenings for children. Preventive care services for both adults and children cover the costs of immunizations for a variety of diseases like influenza, chickenpox, and measles.
"Think of preventive care as maintenance for your body," said Hargrove. "You don't wait for your car to break down before you get an oil change—your health should work the same way."
2.Use prescription drug coverage—including accessing savings available through the health plan.
Prescription medications can quickly become very costly and a strain on your budget. If you haven't checked in with your insurer or reviewed your benefits structure, you may be missing out on prescription drug coverage discounts that are part of your health plan, helping you save money each time you request a refill.
Most health plans employ pharmacy benefits specialists whose goal is to help members find low-cost medications, such as generics for otherwise high-priced drugs.
Select Health collaborates with Rx Savings Solutions to help members save money on prescriptions through an innovative pharmacy savings tool and can also suggest lower-cost medications that may work just as effectively as those you're currently taking.
Additionally, Select Health and Mark Cuban Cost Plus Drugs have created an innovative relationship – Select Health members will now have access to more than 1,000 prescription products at potentially lower prices than traditional pharmacy locations. This collaboration encompasses medications for many common conditions, including high blood pressure, certain cancers, dementia, asthma, diabetes, and more.
Select Health members can review their formulary, a list of covered medications on their health plan, and potentially identify less-expensive alternatives if they log into the Select Health Member Login.
"Prescription savings often fly under the radar," Hargrove said. "If you haven't checked your plan's pharmacy tools, you could be leaving real money on the table."
3.Maximize any wellness benefits and rewards that are part of the health plan.
Many health plans have added benefits and extras that individuals either don't know about or forget to use. Taking advantage of items such as wellness benefits wrapped into your health plan can make a huge difference for individuals and families.
"Wellness rewards turn healthy choices into real value," said Hargrove. "It's not just about exercise—it's about making your everyday routine work harder for your health and your wallet."
Review your health plan to see what wellness benefits are available to you. Select Health members can learn more about what wellness rewards their plan offers via online resources.. Don't let unique benefits go unused because they not only help you start living a healthier lifestyle, but you can save money.
Your health insurance is there for you to cover medical care, services, and prescriptions, and help you live a healthy lifestyle for years to come. Start by taking these three steps to utilize your health plan wisely for the remainder of the year.
If you have questions about coverage options or extras that add value to a health plan for individual and families, reach out to Select Health online at selecthealth.Org or call 1-855-442-0220.
Savvy Senior: Does Medicare Cover Annual Physical Exams?
Dear Savvy Senior,
Does Medicare cover annual physical exams? I've gotten a physical every year since I turned 50 and would like to find out what Medicare covers when I sign up in a few months. — Almost 65
Dear Almost,
No, Medicare does not pay for annual physical exams, but it does cover a one-time "Welcome to Medicare" checkup during your first year after enrolling in Part B. And after that, it covers annual wellness visits to keep track of your health. Here's what you should know.
In an annual physical, a doctor examines you, might do bloodwork and other tests, and looks for problems, even though you don't have a specific complaint or risk.
The Welcome to Medicare checkup and annual wellness visits are different. They focus primarily on preventive care.
Your doctor will review your risk factors, develop a personalized health plan for you, check that you're up to date with preventive tests such as cancer screenings and flu shots, and may refer you for other tests. Here's a breakdown of what these exams may include.
The Welcome to Medicare checkup is an introduction to Medicare and focuses on health promotion, disease prevention and detection to help you stay well. It's an opportunity for your doctor to assess your health and provide a plan for care. During this visit your doctor will:
• Take your height, weight, and blood pressure measurements, and calculate your body mass index (BMI).
• Ask about your personal and family health history.
• Give you referrals for other care as needed.
• Assess your potential for depression.
• Provide a simple vision test.
• Recommend vaccines, tests, screenings and other preventive services you need to stay healthy.
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• Offer to talk with you about creating advance directives.
The annual wellness visit includes some of the same elements as the Welcome to Medicare checkup. For example, your doctor will review your medical history, record your vital information and give you an opportunity to talk about advance directives. Your doctor may also provide the following services:
• Create a screening checklist for recommended preventive services for the upcoming year.
• Look at health risks and treatment options.
• Perform a cognitive assessment to look for signs of dementia.
• Provide personalized health advice.
• Review your current prescriptions.
• Study risk factors for opioid problems if you have a prescription for opioids, and screen for potential substance use disorders.
The Welcome to Medicare and annual wellness visits are fully covered by Medicare Part B without any out-of-pocket costs. You don't need the Welcome to Medicare visit to qualify for later annual wellness visits, but know that Medicare won't pay for a wellness visit during the first 12 months you have Part B.
During these visits, the provider may order additional tests or procedures that may be subject to Medicare's deductibles, copayments or coinsurance.
Make sure that when you book your appointment, you specifically ask for the Welcome to Medicare checkup or annual wellness visit to ensure Medicare covers it. Otherwise, you may have to pay for the visit.
If you're enrolled in Medicare Advantage, you'll probably need to use an in-network provider for the wellness visits to be covered. Some Medicare Advantage plans also cover annual physicals in addition to the wellness visit. Check your plan for details.
Send your questions or comments to questions@savvysenior.Org, or to Savvy Senior, P.O. Box 5443, Norman, OK 73070.
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