Preventive Care — Proven to Work

In March, a federal judge in Texas struck down requirements that insurers and employers cover free preventive screenings for cancer, heart disease and other diseases under the Affordable Care Act (ACA). It’s a bold decision, and one that calls attention to the critical conversations taking place nationwide — as far up as the Supreme Court — about the role preventive care plays in our healthcare system.

This decision contrasts with the trends we’ve seen in recent years – for insurers to cover even more preventive care services such as COVID-19 testing, vaccines, pediatric mental health care, and more. Expansion in coverage has stemmed not only from the pandemic, but also from preventive care being a proven, well-researched approach to ensure cost savings and better health outcomes across the board.

The importance of comprehensive preventive coverage cannot be stressed enough, especially since we know that cost is the top reason patients delay or defer care. Strong preventive coverage decreases overutilization of the emergency department and helps individuals detect catastrophic diseases early on through screenings – and potentially treat them before they get worse. Eliminating cost-sharing for preventive care also helps reduce racial and ethnic disparities as has been proven by an uptick in preventive screenings among certain populations under the ACA.

With Comfort®, Gravie has taken it one step further by covering not only a wide range of services not typically categorized as “preventive,” but also other services that lean in that direction on the spectrum of care – everyday things like labs and imaging, generic prescriptions, and urgent care visits. These services aren’t considered preventive by most traditional carriers but are crucial in an effort to empower individuals to prioritize and protect their health and wellbeing in the long run. It’s an approach that’s proving to be affordable and sustainable for both members and employers.

If other states follow in Texas example by resurrecting barriers to coverage of preventive screenings, we won’t see the effects until years down the road, as more and more people will miss early signs of these sometimes catastrophic diseases.

We know preventive care works, and that employers and brokers don’t have to wait for mandates to tell them what type of coverage is most beneficial to the wellbeing of employees. Instead, we can turn to forward-thinking benefits providers who are looking closely at claims data and paving the way for better access to proven and effective care.