Under ACA, preventive care is 100% covered

Dr. Right

Under the Affordable Care Act (ACA), preventive care must be covered by insurance plans 100%. Preventive care helps keep people healthier and reduces health care expenses in the long term.

Before we dive into the list of what’s covered, it’s important to note that there’s a difference between “preventive” care and “diagnostic” care. Your preventive care is covered. But, if your doctor wants to examine any specific health issues further, that falls in the “diagnostic” category, which means you’ll likely be paying a copay or coinsurance. Keep that in mind when you visit your doctor.

Preventive care is covered under every level of health insurance on the Marketplaces. Even catastrophic-level policies cover preventive care. See our Marketplaces post for more information. And now, here’s the big list of what’s covered for adults, women, and children.

What’s Covered:

Preventive care coverage requirements for health insurance plans

Adults Women Children
Abdominal aortic aneurysm screening Anemia screening during pregnancy Alcohol and drug use assessments for adolescents
Alcohol misuse screening and counseling Bacteriuria urinary tract or other infection screening during pregnancy Autism screening for children at 18 and 24 months
Aspirin use BRCA counseling about genetic testing for women at higher risk Behavioral assessments
Blood pressure screening Breast cancer mammography screenings for age 40 and older Blood pressure screening
Cholesterol screening for certain ages or at higher risk Breast cancer chemoprevention counseling for women at higher risk Cervical dysplasia screening for sexually active females
Colorectal cancer screening for people age 50 or older Breastfeeding support and counseling plus access to breastfeeding supplies Congenital hypothyroidism screening for newborns
Depression screening Cervical cancer screening for sexually active women Depression screening for adolescents
Type 2 diabetes screening for people with high blood pressure Chlamydia infection screening for younger women and others at higher risk Developmental screening for children under age 3
Diet counseling for people at higher risk of chronic disease Contraception and patient education and counseling Dyslipidemia screening for children at higher risk of lipid disorders
HIV screening for people at higher risk Domestic and interpersonal violence screening and counseling Fluoride chemoprevention supplements
Immunization vaccines Folic acid supplements for women who may become pregnant Gonorrhea preventive medication for newborns’ eyes
Obesity screening and counseling Gestational diabetes screening for women 24 to 28 weeks pregnant Hearing screening for newborns
Sexually transmitted infection (STI) prevention counseling for people at higher risk Gonorrhea screening for women at higher risk Height, weight, and body mass index measurements for children
Tobacco use screening and cessation interventions Hepatitis B screening for pregnant women at their first prenatal visit Hematocrit or hemoglobin screening
Syphilis screening for people at higher risk HIV screening and counseling Hemoglobinopathies or sickle cell screening for newborns
HPV DNA test every three years for women with normal cytology results who are age 30 and older HIV screening for adolescents at higher risk
Osteoporosis screening for women older than 60 Immunization vaccines
Rh incompatibility screening for pregnant women Iron supplements for babies age 6 to 12 months at risk for anemia
Tobacco use screening and intervention; expanded counseling for pregnant tobacco users Lead screening for children at risk of exposure
Sexually transmitted infections (STI) counseling for sexually active women Medical history
Syphilis screening for pregnant women and women at increased risk Obesity screening and counseling
Well-woman visits for preventive services for women under 65 Oral health risk assessment for children up to age 10
Phenylketonuria (PKU) screening for newborns
Sexually transmitted infection (STI) prevention counseling and screening for adolescents at higher risk
Tuberculin testing
Vision screening
Source: http://www.hhs.gov/healthcare/facts/factsheets/2010/07/preventive-services-list.html


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