ACA question, shouldn't all immunizations be covered?

[Ser Scot A Ellison]

My insurance is attempting to claim immunization boosters are not covered to a pretty penny. Isn't the ACA supposed to be all about preventitive care? I can't imagine there isn't a madate about childhood vaccines.

[Edda van Heefmstra Ruston]

Are you insured directly by the ACA now, Scot?

To be marginally less snarky, it really depends on the age of the patient and what the vaccine is for. It may also depend on whether it's a booster or an initial vaccination, but you did at least provide that info in your OP.

http://www.cdc.gov/vaccines/adults/find-pay-vaccines.html (See, under Private Insurance, the section starting "All Health Insurance Marketplace plans and most other private insurance plans must cover the following list of vaccines without charging a copayment or coinsurance when provided by an in-network provider. "

http://www.hhs.gov/healthcare/facts/factsheets/2010/09/The-Affordable-Care-Act-and-Immunization.html

http://www.vaccines.gov/getting/pay/

http://www.immunize.org/presentations/tan_impact_ACA_immunizations.pdf

[Ser Scot A Ellison]

Aoife,

No, but there are directives from the ACA that say what must be covered by various insurance plans, right? Wasn't that what the fight over birthcontrol and Hobby Lobby was all about? Does the ACA demand birthcontrol be covered but not immunizations? That can't be the case, can it?

[Edda van Heefmstra Ruston]

Aoife,

No, but there are directives from the ACA that say what must be covered by various insurance plans, right? Wasn't that what the fight over birthcontrol and Hobby Lobby was all about? Does the ACA demand birthcontrol be covered but not immunizations? That can't be the case, can it?

See my edit.

[Ser Scot A Ellison]

Aoife,

Thank you. This is more of a WTF??? Than an attack on the ACA because I couldn't imagine Vaccines were not included. I found several of those links and this is just bizarre. My HR's managers reaction when I emailed her the bill was "what???"

[TerraPrime]

Ooops, ninja link'ed by Aoife.

From https://www.healthcare.gov/preventive-care-benefits/ :

All Marketplace plans and many other plans must cover the following list of preventive services without charging you a copayment or coinsurance. This is true even if you haven’t met your yearly deductible.

This applies only when these services are delivered by a network provider.

Bolded for emphasis.

So your plan might be the few that are exceptions to this, if it is not a Marketplace plan. Is it a grandfathered plan?

[Ser Scot A Ellison]

TP,

I've been told it is. But a "family plan" that doesn't cover childhood vaccines?

[Aemon Stark]

Aoife,

No, but there are directives from the ACA that say what must be covered by various insurance plans, right? Wasn't that what the fight over birthcontrol and Hobby Lobby was all about? Does the ACA demand birthcontrol be covered but not immunizations? That can't be the case, can it?

So you should be lobbying to expand its coverage then?

[TerraPrime]

TP,

I've been told it is. But a "family plan" that doesn't cover childhood vaccines?

IIRC, there were many exceptions made for plans that are to be grandfathered. Here's a list:

Q2: What are the advantages of grandfathered status?

Grandfathered plans are not required to meet these PPACA requirements:

• Coverage of preventive care without employee cost-sharing, including contraception for women.

• Limitations on out-of-pocket maximums (starting in 2014).

• Essential health benefits, metal levels and deductible limits (starting in 2014; these only apply to insured small group plans).

• Modified community rating (starting in 2014; this only applies to insured small group plans).

• Guaranteed issue and renewal (starting in 2014; this only applies to insured plans).

• Nondiscrimination rules for fully insured plans (requirement has been delayed indefinitely).

• Expanded claims and appeal requirements.

• Additional patient protections (right to choose a primary care provider designation, OB/GYN access without a referral , and coverage for out-of-network emergency department services).

• Coverage of routine costs associated with clinical trials (starting in 2014).

• Reporting to HHS on quality of care (requirement has been delayed indefinitely).

- See more at: http://www.shrm.org/hrdisciplines/benefits/articles/pages/faqs-grandfathered-plans.aspx#sthash.7blXlZVB.dpuf

Sounds to me like the beef is with your employer's decision to keep a grandfather'd plan. All new post-PPACA plans cover vaccination, it seems. And since it's a grandfathere'd plan, it never covered vaccination to begin with, even prior to PPACA. I suppose you can be angry that the PPACA wasn't powerful enough to force your old plan to meet the vaccination requirement?

[Andriy Czarchenko]

To answer the question posed on the title of this thread. :devil:

Of course not. There are plenty of vaccines that are only needed if you travel to certain parts of the world and I don´t see why those should be automatically included. :box: :cheers:

[Aemon Stark]

That's true, but I'm not sure why MMR or DTaP wouldn't be covered.

[Andriy Czarchenko]

Oh, no question there.

[IheartIheartTesla]

Not sure why Hobby Lobby should pay for vaccines to prevent diseases caused by sexytimes, it probably goes against their religious principles. Ergo, no need to pay for the HPV vaccine, for example.

Don't blame me, blame the Supreme Court.

[Ser Scot A Ellison]

IHT,

These are basic childhood vaccines.

[TerraPrime]

Not sure why Hobby Lobby should pay for vaccines to prevent diseases caused by sexytimes, it probably goes against their religious principles. Ergo, no need to pay for the HPV vaccine, for example.

Don't blame me, blame the Supreme Court.

Oh don't worry. The anti-sex brigade is already against the HPV vaccine, citing that it will encourage promiscuity, before the arrival of the shit-tastic SCOTUS decision.

In fact, why stop there? Oh, you're planning a trip to Mecca because it's part of your religious need? And your doctor says you should get Hepatitis A vaccine before you travel? Why no, we won't be paying for that because it's against our religion to acknowledge that your religion is valid.

[Tears of Lys]

How can you know if the insurance plan you're on has been grandfathered?

I'm self-employed, so I cover my own health care bill to the tune of $500-something a month. We (SO and I) knew this was coming when he retired and saved accordingly. What we're sort of surprised by is how the cost of certain medications is so exorbitant.

Is it my imagination, or did the cost of generic drugs recently take a rocket ship to the moon? This past weekend I decided not to pay for my headache medication Fioricet. The pharmacist warned me before he rang it up that it was going to cost me over 200 bucks. I decided to suffer instead.

Before anyone leaps to the defense of the ACA, let me first say that I place blame for this situation squarely on the shoulders of drug manufacturers, who, it seems to me, are really taking advantage of the situation. This is yet another example of the supposedly "free market" not working.

Thank goodness it wasn't asthma medication, though.

[Ser Scot A Ellison]

My allopurinol has gone from $2.75 for a month's supply to about $10.00 for the same amount. This is the generic drug. I'm really frightened to see what my Prevestaten is going to cost in December.

[TerraPrime]

If you have the same plan now (except maybe changes in premium) as you did in since March 2010, then you either have a grandfather'ed plan or your plan was already PPACA-compliant. Chances are, it's the former, as very few pre-PPACA plans have the cost-profit ratio cap in it.

[Ser Scot A Ellison]

I'm just curious where these price increases are coming from. The Pharmisist said this was not due to insurance and the price of Allopurinol almost quadrupeled.

[Wee baby Shamus]

It isn't that hard to figure out why the price of your medication is increasing.