This week, I answered a couple of questions from readers about preventive health benefits and looked into coverage options for people who travel frequently.
Why aren鈥檛 there preventive health recommendations for men like there are for women under the health law? Women and聽breast cancer get so much attention by the health care community. Heart health, diabetes, prostate cancer and colon cancer are a few examples of opportunities for education and preventive screening for men.聽
There are many recommendations for men鈥檚 preventive care in the health law, although most of the examples you mention聽apply to women as well. Under the law, have to be provided without charging people anything out of pocket. The independent panel of medical experts currently recommends that women and men be screened for high blood pressure, elevated cholesterol and blood sugar levels, and for colorectal cancer.聽It advises against routinely screening men for prostate cancer, however, noting that it reduces death from the disease.聽( an annual prostate cancer test, but you may owe a copayment.)
The drafters of the health law paid special attention to , creating additional recommendations targeted specifically at them. This was done in part to address recognized gaps in women鈥檚 services, especially in the areas of sexual and reproductive health, said Adam Sonfield, senior policy manager at the Guttmacher Institute, a reproductive health research and policy organization.
The federal government is in the process of .聽If it adopts the this fall, insurers will begin to cover condoms and vasectomies for men without charge. Adding this no-cost benefit would address an inequity in current coverage rules and help both women and men avoid unwanted pregnancies.
I am 74 years old and on Medicare. My mother died of ovarian cancer and two maternal aunts and my paternal grandmother had breast cancer. Does Medicare cover BRCA testing?
Medicare genetic testing for the two BRCA mutations that are associated with an increased risk of breast and ovarian cancer if you鈥檝e already been diagnosed with cancer and have a family history that indicates testing is appropriate.
Throughout its history, the Medicare program, which provides health benefits for older and disabled Americans, has focused on treating injury and illness, not preventing them. Although the program now covers some cancer screening tests such as mammograms and colonoscopies, those changes were specifically authorized by Congress.
It鈥檚 a wrongheaded approach, said Dr. J. Leonard Lichtenfeld, deputy chief medical officer at the American Cancer Society. 鈥淚鈥檓 incensed that this is not covered,鈥� he said.
The BRCA test results could be important not only to the woman聽but also to her siblings and children, Lichtenfeld said.
There are non-insurance options for testing, Lichtenfeld noted. , for example, offers a genetic test that analyzes 30 genes associated with hereditary cancers, including BRCA 1 and BRCA 2, for $249.
Are there any options available for people with marketplace plans who travel regularly? Emergency costs for an accident should be covered, but what about follow-up care after an accident or an illness while traveling? How does this work with increasingly narrow provider networks?
The situation you describe can be tough to manage. Under the health law, an to pay more for care in an emergency department that鈥檚 not in your provider network than it would have mandated for emergency care in network.
But once you leave the emergency department, you may get hit with out-of-network charges if you鈥檙e admitted to the hospital, for example, or need other follow-up care and are far from home.
You have a few options. Individual Blue Cross Blue Shield plans that are may offer access to BCBS providers nationwide and overseas.
Be sure to check with individual Blues plans before signing up if that type of coverage is important to you, said Paul Rooney, vice president of carrier relations at聽, an online insurance broker.
鈥淪ome of the local Blues are pulling [that coverage] from their offerings,鈥� he said.
You might consider buying an . These plans typically pay a fixed dollar amount to offset your costs if you鈥檙e injured in an accident. But they can be tricky, said Nate Purpura, vice president of consumer affairs at聽eHealth.com. The policies don鈥檛 cover pre-existing medical conditions, and the insurer might deny a claim that it considers related to an earlier medical problem, he said.
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