Under the Affordable Care Act (ACA), preventive care must be covered by most group and individual health insurance plans at 100% without any cost-sharing requirements. Preventive care helps keep people healthier and reduces health care expenses in the long term.
The ACA requires that group health plans and insurers that are subject to the preventive services coverage mandate provide coverage for all of the following preventive services without imposing any copayments, coinsurance, deductibles or other cost-sharing requirements when delivered by in-network providers: evidence-based items with an A or B rating recommended by the United States Preventive Services Task Force (USPSTF); immunizations recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention; preventive care and screenings supported by the Health Resources and Services Administration (HRSA) for infants, children, and adolescents.
In addition to the list of preventive care for adults and children, the HRSA includes a list of what qualifies as preventive care for women. Online, you can find a comprehensive list of all of the USPSTF, CDC and HRSA guidelines. This list is updated frequently, so if you’re curious as to what qualifies as a preventive benefit, you can always visit the website for the most accurate and updated list.
Most of these preventive care requirements went into effect for new plans on Sept. 23, 2010, and for other plans as they renewed on or after that date, while a few went into effect in 2012. Let’s take a look at what’s special just for women.
Women can take advantage of many preventive care services to help maintain their overall health. The biggest boon is that well-woman visits for preventive services are covered for women under 65 years old. This makes seeing the doctor regularly easier to afford.
Women at higher risk can get BRCA counseling about genetic testing and breast cancer chemoprevention counseling as well as screenings for gonorrhea, syphilis, chlamydia, and cervical cancer. Counseling for sexually transmitted infections is also covered. HIV screening and counseling made the list as well.
Women age 30 and older with normal cytology (cancer screening) results are covered for an HPV DNA test every three years. Women age 40 and older can get breast cancer mammography screenings, while women 60 and older can get osteoporosis screening.
Screening and counseling for domestic and interpersonal violence are also covered. Tobacco use screening and intervention are covered, along with expanded counseling for pregnant tobacco users, which brings us to …
Pregnant women have coverage for a wide variety of tests and screenings under the ACA. For women who may become pregnant, folic acid supplements are covered if you have a prescription for them. Before pregnancy, the new rules call for coverage of all FDA-approved contraceptives available by prescription, plus patient education and counseling.
For women who are pregnant, anemia screening, urinary tract infection screening, gestational diabetes screening, Hepatitis B screening, and syphilis screening are all on the list. Screening for Rh incompatibility is also covered. After delivery, breastfeeding support, supplies, and counseling are covered.
Find out more
Preventive care is covered under every metal level of health insurance coverage that will be available on the Health Insurance Exchanges. Even catastrophic-level policies cover preventive care. Unlike many provisions of the ACA that go into effect next year, these services are covered under new health plans right now. Read more about preventive services for women and watch for news as the rules develop.