Key Takeaways
Researchers have documented racial and ethnic gaps in insurance reimbursement for screenings and shots that should be freeClaims from patients who are non-white or have low incomes are more often rejected, saddling them with unexpected costsPatients with public as well as private insurance are affected
MONDAY, Oct. 7, 2024 (HealthDay News) — Two new studies show insurers continue to deny claims for preventive care that is supposed to be free under Obamacare.
And insurers are more apt to reject claims from patients who are Asian, Black or Hispanic as well as those with low incomes, researchers recently reported in the journal JAMA Network Open.
“What we document is that there inequities at the starting line,” said study co-author Michal Horny, an assistant professor of health policy and management at the University of Massachusetts Amherst, adding: “We want to prevent preventable diseases. It saves money down the road if we don’t have to treat the diseases that could have been prevented in the first place.”
A related study published in the American Journal of Preventive Medicine found that patients with private insurance incurred charges for preventive care that should have been fully covered. This occurred in 40% of visits.
Since 2010, when President Barack Obama signed the Affordable Care Act into law, most health plans are required to cover preventive services such as shots and screenings.
But the new research shows that patients continue to be left without access to this care or shouldering unexpected out-of-pocket costs.
“Preventive care provides a lot of value to patients and healthcare systems and population health overall,” Horny said in a university news release. “That’s why the Affordable Care Act mandated health insurers to provide recommended preventive services to their beneficiaries at no cost.”
For the JAMA study, his team looked at 2.5 million preventive care claims filed between 2017 and 2020 by 1.5 million patients.
Besides racial gaps in coverage, low-income patients were 43% more likely than high-income patients to have claims denied, the study found.
Billing for denied claims also showed disparities.
For patients making less than $30,000, the median charge for a denied claim was $412, meaning half were charged more, half less. That compared to a median charge of $354 for patients with household incomes between $50,000 and $74,000 and a $365 charge for patients earning $100,000 or more.
When claims were denied, researchers found non-Hispanic white patients were charged less than any other ethnic group.
“These findings suggest that experiences of patients seeking free preventive care differ on the basis of their demographics, leading to inequities in accessing basic preventive care,” the researchers wrote.
The second study uncovered similar gaps: Privately insured patients were charged for 40% of preventive care visits that should have been free.
Both studies looked at claims data for seven preventive services that are supposed to be fully covered: birth control, wellness visits and screenings for diabetes, depression, cholesterol and cancers of the breast and colon.
In the second study, less educated patients were 9.4% more likely to face out-of-pocket costs than those with college degrees. On the flip side, patients earning under $50,000 had 10.7% lower odds of being charged than high-income patients.
Researchers said their work underscores that the result is uneven access to preventive care.
More information
Information about insurance coverage for preventive care is available at healthcare.gov.
SOURCE: University of Massachusetts Amherst, news release, Oct. 3, 2024
What This Means For You
If insurers deny coverage for preventive care, ask why. Obamacare provides for free screenings and shots.
