Maine news, sports, weather from Portland Press Herald / Maine Sunday Telegram, Portland, Maine

July 25, 2010

Co-pay cuts expected to curb illness

When the Affordable Care Act kicks in, Mainers will have one less reason to avoid preventive care.

By John Richardson jrichardson@mainetoday.com
Staff Writer

Annual physical exams, blood tests, routine cancer screenings and other preventive health care services will soon be less costly for many Mainers.

New federal rules set to take effect over the next several months will eliminate preventive care co-pays and deductibles for people covered by Medicare and new private insurance plans.

Not everyone will benefit from the changes, which are part of the federal health care reform law passed in March. But it's a trend that should keep patients healthier and health care costs lower, according to Maine health care providers.

"If we can detect and find things early, you're definitely going to prevent the expensive downstream costs," said Betsy Johnson, a physician and medical director at Portland-based Martin's Point Health Care.

Seniors who have Medicare coverage currently have to pay the entire cost of annual physicals and as much as 20 percent of the cost for periodic tests, such as mammograms and colonoscopies. As of Jan. 1, Medicare will pay 100 percent of those costs, as well as fully covering some other services.

Some privately insured patients will see similar changes starting this year.

Beginning Sept. 23, all new private health insurance plans will cover 100 percent of the costs of breast and colon cancer tests, as well as checkups for children and pregnant women, and other services.

However, people covered under private health plans that existed before March 23 -- including the vast majority of those covered through their jobs -- will continue to pay their existing out-of-pocket costs until they or their employers change to new plans. Plans that predate the Affordable Care Act are considered exempt, or grandfathered, as long as they don't significantly reduce benefits or increase employee premiums.

The phase-in is one of the first pieces of the federal reform law to take effect and is part of the larger transition toward a new health insurance market that advocates hope will reduce the runaway cost of health care.

In the private market, an estimated 41 million Americans should benefit from the new policy this year and a total of 88 million should benefit by 2013, according to the U.S. Department of Health and Human Services. About 98 million people are covered by health plans that are grandfathered and would not be affected.

The expansion of coverage benefits could increase insurance premiums by 1.5 percent on average, according to the department.

On the other hand, encouraging better preventive care will ultimately save both lives and money by catching illnesses early and avoiding expensive surgery and critical care, advocates said.

"I think we'll see more people availing themselves of these tests because they don't have the financial burden," said Carol Rancourt, a Medicare expert with the Southern Maine Area Agency on Aging. "In the early days, of course you're not going to have the costs savings. But once you've intervened with enough people and you see you're having less colon cancer surgeries and less mastectomies (there will be savings). When you think about it, it can be substantial."

Seniors covered by Medicare can potentially save hundreds of dollars a year for preventive care services. An annual physical exam may cost $100 to $200 and is not now covered by the government insurance plan.

Dan McCormack, chief executive of South Portland-based Intermed, said he expects an increase in calls for physicals early next year, although the network of medical practices has not yet seen any impact.

"To the extent that people can have access to preventive care more readily or in a more affordable way, that's a good thing," he said.

(Continued on page 2)

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