Court Ruling May Spur Competitive Health Plans to Bring Back Copays for Preventive Services

by | Sep 15, 2022 | Health

Tom and Mary Jo York are a health-conscious couple, going in for annual physicals and periodic colorectal cancer screening tests. Mary Jo, whose mother and aunts had breast cancer, also gets regular mammography tests.

The Yorks, who live in New Berlin, Wisconsin, are enrolled in Chorus Community Health Plans, which, like most of the nation’s health plans, is required by the Affordable Care Act to pay for those preventive services, and more than 100 others, without charging deductibles or copays.

Tom York, 57, said he appreciates the law’s mandate because until this year the deductible on his plan was $5,000, meaning that without that ACA provision, he and his wife would have had to pay full price for those services until the deductible was met. “A colonoscopy could cost $4,000,” he said. “I can’t say I would have skipped it, but I would have had to think hard about it.”

Now health plans and self-insured employers — those that pay workers’ and dependents’ medical costs themselves — may consider imposing cost sharing for preventive services on their members and workers. That’s because of a federal judge’s Sept. 7 ruling in a Texas lawsuit filed by conservative groups claiming that the ACA’s mandate that health plans pay the full cost of preventive services, often called first-dollar coverage, is unconstitutional.

U.S. District Judge Reed O’Connor agreed with them. He ruled that the members of on …

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