Millions of Ohioans have taken advantage of “free” preventive care services made available under the federal health care reform act.

But experts say millions more are likely missing out on diabetes screenings, mammograms, colonoscopies and so-called wellness visits because they are simply unaware the services are available with no cost-sharing, such as co-pays or deductibles.

“My general impression is people are not aware that these services are a consequence of the (Patient Protection and Affordable Care Act),” said Dr. Margaret Dunn, a practicing surgeon and president and chief executive of Wright State Physicians, a group of more than 130 doctors who serve on the faculty of Wright State University’s Boonshoft School of Medicine.

Dunn said most health insurance policies are so rife with confusing and conflicting language that many consumers are simply uncertain about which treatments are covered.

“Healthcare in the United States is so complicated that people are just chronically confused about what their insurance covers or doesn’t cover,” she said. “I see a lot of patients in my practice that have breast issues or have had breast cancer, and when I’m talking to them about screening mammograms as a preventive service covered by this provision of the ACA where you won’t have a co-pay….it’s a completely novel conversation to them.”

Dunn thinks most insurance companies could provide more clarity: “They make some effort to communicate about these issues to their customers, but I don’t think they’re particularly effective.”

Still, the word is getting out.

Last year, 2,138,000 men, women and children in Ohio received free preventive services or a free annual wellness visits with their doctors, according to figures compiled by the U.S. Department of Health and Human Services. They were among an estimated 54 million Americans who gained preventive service coverage with no cost-sharing in 2011.

The health care act, commonly referred to as Obamacare, requires all private plans — including individual, small group, large group, and self-insured plans — to provide coverage without cost sharing for a variety of preventive health services, including tobacco cessation treatments, well-child visits, and flu shots for children and adults.

The law also makes preventive services free for most people on Medicare.

More than 937,000 people with Medicare in Ohio received free preventive services or wellness visits with their doctor last year, and for the first nine months of this year more than 705,000 people with Medicare received free preventive services.

“With more people taking advantage of these benefits, more lives can be saved, and costly, and often burdensome, diseases can be prevented or caught earlier,” Health and Human Services Secretary Kathleen Sebelius said in a statement.

More preventative services are expected to be included in health insurance plans as federal changes under the health care act come into effect, but human nature is likely to keep many eligible enrollees from taking advantage of the services, said Bryan Bucklew, president and chief executive of the Greater Dayton Area Hospital Association.

“People have been conditioned to only go to the doctor when something is wrong,” he said. “Preventive care or wellness care still hasn’t entered into the mainstream consciousness of a lot of people.”

Part of the reason is the the health care system is geared more heavily toward treatment than prevention, he said.

“The system is “incentivized” to treat people that need things done; a procedure, a medicine, a shot,” Bucklew said. “So our biggest issue is making sure people have access to wellness care…and do not have to use the emergency rooms for routine or primary care.”

The Health and Human Services Department reports the average cost for an emergency room visit nationwide is about $1,300, versus $200 for a visit to a doctor’s office, and overuse of ER is one of the of the main reasons for the rising cost of health care.

“Yearly checkups, making sure you’re getting a flu shot, some of those basic things, can save the individual and the overall community a lot of money,” Bucklew said.