If you’re like 40% of other Americans, you probably have a high deductible health plan through your employer. As of 2018, the minimum deductibles for high deductible health plans are:
- $3,450 for individual coverage
- $6,900 for family coverage
This means you’ll have to pay that amount before your insurance kicks in and starts to pay. If you have health complications or have been told you may need surgery, you might just end up meeting your deductible early in the year. While that does mean your insurance will begin to pay sooner, it also means you’re shelling out a lot of money upfront. Money that you may not have.
Is there a solution? How can people who know that they’ll need surgery soon plan for preventive care in the new year? If you know you might need surgery, creating a plan for how to address the cause of your condition can help minimize healthcare costs and surgery complications. There’s also the possibility that, by taking preventive measures, you may not end up needing surgery at all.
Below, you’ll learn which preventive care services are covered in 2018 and suggestions for planning for healthcare in the new year, based on the type of surgery you need.
What is preventive care?
Preventive care is health care received in order to prevent or detect illness before it becomes a problem. Most health insurance plans are legally required to cover preventive care services at no cost to you. The Centers for Disease Control (CDC) recommends utilizing as many of the preventive care services covered by your health plan as possible. When an illness or health condition is detected at an early stage, treatment is likely to work the best.
What types of preventive care are covered in 2018?
Though the administration has eliminated the requirement for people to carry health insurance, not much else about the Affordable Care Act (ACA) has changed. This is good news because it means that people with insurance are still able to receive free preventive care, as mandated by the government. This means you won’t have to pay a co-pay or co-insurance, even if you haven’t met your deductible for the year. The preventive care services covered in 2018, as listed on Healthcare.gov, include:
- Abdominal aortic aneurysm one-time screening, for men of specified ages who have ever smoked
- Alcohol misuse screening and counseling
- Aspirin use to prevent cardiovascular disease for men and women of certain ages
- Blood pressure screening
- Cholesterol screening for adults of certain ages or at higher risk
- Colorectal cancer screening for adults over 50
- Depression screening
- Diabetes (Type 2) screening for adults with high blood pressure
- Diet counseling for adults at higher risk for chronic disease
- Hepatitis B screening for people at high risk, including people from countries with 2% or more Hepatitis B prevalence, and U.S.-born people not vaccinated as infants and with at least one parent born in a region with 8% or more Hepatitis B prevalence.
- Hepatitis C screening for adults at increased risk, and one time for everyone born 1945 – 1965
- HIV screening for everyone ages 15 to 65, and other ages at increased risk
- Immunization vaccines for adults — doses, recommended ages, and recommended populations vary:
- Hepatitis A
- Hepatitis B
- Herpes Zoster
- Human Papillomavirus (HPV)
- Influenza (flu shot)
- Varicella (Chickenpox)
- Lung cancer screening for adults 55 – 80 at high risk for lung cancer because they’re heavy smokers or have quit in the past 15 years
- Obesity screening and counseling
- Sexually transmitted infection (STI) prevention counseling for adults at higher risk
- Syphilis screening for adults at higher risk
- Tobacco Use screening for all adults and cessation interventions for tobacco users
It’s important to remember that these preventive services are only free when you see a doctor in your insurance network. Otherwise, you may end up paying the difference between the cost of care and the amount your insurance plan covers for out-of-network care. If you’re not sure if a doctor is in-network, call your insurance provider directly.
If I know I need surgery, can I still get preventive care for free?
It may seem counterintuitive that you can get preventive care if you know you’re at risk for a health condition that requires surgery. The reality is that all marketplace health plans and many other health plans do cover preventive care for pre-existing conditions. If your employer is self-insured, it’s a good idea to check with your benefits team or HR manager to find out what is and is not covered.
How to plan for health care in 2018
Planning for health care doesn’t necessarily mean just utilizing preventive care services. However, since these services are free to you, it’s a great place to start. The type of surgery you need should influence the type of health care you plan for. Here are some of the preventive services you can plan for in 2018 to help make your surgery more successful, or avoid surgery altogether.
If you need bariatric (weight loss) surgery in 2018, you should plan for…
- Diet counseling — Getting advice from a nutritionist is one way you can get on the right path toward a healthier lifestyle. Part of getting bariatric surgery is learning how to eat healthier, so after surgery you can maintain your weight loss.
- Obesity screening and counseling — If you’ve been told you need weight loss surgery, you’ve probably already gone through an obesity screening to see if you meet the weight requirements for surgery. You can also receive free counseling before and after your surgery.
- Diabetes (Type 2) screening — Type 2 Diabetes is a condition that many people who are obese deal with. If you’re not sure if you have type 2 diabetes but you’re worried, it’s a good idea to get a screening.
- Depression screening — One of the qualifications for getting bariatric surgery is that you’re in good mental health. The emotional toll of weight loss surgery can be intense, so you’ll need to be evaluated by a mental health professional. Getting a depression screening before your evaluation can help you learn effective coping skills.
- Tobacco use screening — Tobacco use can lead to a higher risk of complications during surgery. If you smoke, talk to your healthcare provider about cessation options long before you get your surgery.
- Cholesterol screening — People who are overweight tend to have high cholesterol levels. It’s important to manage this, to help you get and stay healthy. If you want a cholesterol screening, all you have to do is ask your doctor. Having high cholesterol during surgery puts you at a higher risk of complications, so be sure to get it under control ahead of time.
If you need a knee or hip replacement in 2018, you should plan for…
- Blood pressure screening — High blood pressure is another condition that can make surgery riskier. If a blood pressure screening finds that you do have high blood pressure, you can work with your doctor to get it under control before your surgery.
- Diet counseling — Though most hip and knee replacements are due to some form of arthritis affecting the joints, being overweight can exacerbate the problem. Before your surgery, it’s recommended that you receive diet counseling, so a professional can help you lose weight. This comes with two major benefits: losing weight may help improve your knee or hip pain and it may help you avoid or delay knee or hip surgery.
- Tobacco use screening — Again, smokers who need surgery are advised to quit at least 8 weeks before surgery (but quitting any time is better than not quitting at all). Smokers are more likely to have complications during surgery, including an increased risk of death. Thankfully, help to quit smoking is available under preventive care.
If you need spinal surgery in 2018, you should plan for…
- Blood pressure screening — It’s ideal to get your blood pressure to a healthy level before surgery. A blood pressure screening can help give your doctor a starting point and allow them to customize a plan for you. Surgery may not necessarily be stopped or delayed due to high blood pressure; it really depends on your overall health, as well as how bad your blood pressure is.
You should also consider a tobacco screening, as smokers may experience more complications during surgery than non-smokers.
If you need cardiac surgery in 2018, you should plan for…
- Daily aspirin use recommendation — Low-dose aspirin use is often recommended as a way to prevent heart attack or stroke. You can take it on your own but it’s best to get a recommendation from your doctor on whether taking aspirin is the right choice for you.
- Blood pressure screening — As mentioned above, high blood pressure during surgery can make your surgery less safe and less successful. The earlier you get screened, the longer you have to get it in check before surgery.
- Cholesterol screening — Cholesterol and heart disease are often talked about in relation to one another. When your doctor tells you that you may need cardiac surgery, it’s a good idea to ask them to help you lower your cholesterol. This can help surgery go more smoothly or reduce or delay your need for surgery.
Your health is important. The more proactive you are about getting and staying healthy, the less likely it is that you’ll need surgery. Even if you do still need surgery after getting preventive care, your risk will be lowered when you’re in better health overall.
If you’ve been told you need surgery, your Carrum Health benefit offered through your employer can help you get access to the most highly qualified and experienced surgeons doing the surgery you need. All at no cost to you*. Schedule a consultation now.
* Per IRS rules, a portion of the covered travel expenses will be reported as taxable income to the employee. Due to IRS regulations, on HSA plans the deductible applies but coinsurance is waived.