The following are links to two lists of preventive services covered by all Massachusetts health plans, and being phased in nationwide with the Patient Protection and Affordable Care Act of 2010 (PPACA).
Click here to for Adult Routine Preventive Care Recommendations PDF from Massachusetts Health Quality Partners (MHQP- a coalition of physicians, hospitals, health plans, purchasers, patient and public representatives,academics, and government agencies working together to promote improvement in the quality of health care services in Massachusetts).
Additional MHQP preventive care guidelines including Pediatric and Perinatal recommendations can be found here.
Click here for PPACA Covered Preventive Services.
In order to satisfy the Massachusetts Minimum Creditible Coverage standard, a health plan must cover in full (no deductible or copay) all of the services listed in the MHPQ guidelines. In addition, plans must include a $0 annual Wellness visit. The PPACA laws of 2010 essentially duplicate the MHPQ guidelines for eventual enforcement nationwide. Most major carriers in states other than MA are already covering these preventive services.
It should be noted that many preventive tests can also be considered “diagnostic”, under certain circumstances, and then possibly be subject to deductible and/or copays, depending on plan design. For help verifying whether or not a specific test you may need falls under preventive or diagnostic services in your plan, contact us using the form below, or call (413)527-2738.