Understanding Your ACA Preventive Care Benefits

Preventive Care is among the 10 essential benefits required of all ACA-compliant healthcare plans. It covers a broad range of services including immunizations, screenings and treatments to manage chronic conditions and diseases. As long as you use a provider in your plan’s network, they are free of charge, meaning no copays or coinsurance even if you haven’t met your yearly deductible. Covering preventive care is based on the sound premise that it’s much cheaper and more efficient to prevent disease than to treat it. Also, outcomes tend to be better when health problems are detected early on.

And, because provisions of the Affordable Care Act state that insurers can no longer increase your premiums or deny you renewal because of a health condition, there’s no longer any good reason not to take advantage of every preventive service your health insurance entitles you to. 

Here’s a quick guide to the free preventive services for all adults and adult women that your ACA-compliant plan covers, according to the U.S. Department of Health and Human Services and Healthfinder.gov. 

Free preventive services for all adults

• Abdominal aortic aneurysm – a one-time screening for men 65 to 75 who have ever smoked. Left untreated this can be fatal.
• Alcohol misuse screening and counseling.
• Aspirin use – talk with your doctor to see if daily aspirin therapy could reduce your risk of heart attack or stroke. Recommended for men 45 to 79 and women 55 to 79.
• Blood pressure screening – recommended for all adults to detect and treat hypertension, a leading cause of cardiovascular and other diseases such as diabetes.
• Cholesterol screening – a simple blood test to check cholesterol levels, which can put you at risk of heart attack or stroke. Recommended for men 20 to 35 with heart disease or risk factors, all men 35 and older, and all women 20 or older who have heart disease or risk factors.
• Colorectal cancer screening – recommended for all adults over 50, and anyone younger with a family history of colorectal cancer.  Some tests are done every one to two years; others are done every five to 10 years. Your doctor will decide which test is right for you.
• Depression screening – recommended for anyone who is experiencing signs of depression.
• Diabetes Type 2 screening – a simple blood test recommended for all adults with high blood pressure. Diabetes is one of the leading causes of disability and death in the U.S.
• Diet counseling – maintaining a healthy weight can help you prevent heart disease, Type 2 diabetes, high blood pressure, some cancers and osteoporosis. Recommended for all overweight adults at risk of chronic disease.
• HIV screening – recommended for anyone at any age who is at increased risk of HIV exposure.
• Immunization vaccines – these include Hepatitis A & B, Herpes Zoster, Human Papillomavirus, Influenza, Measles, Mumps & Rubella, Meningococcal, Pneumococcal, Tetanus, Diphtheria & Pertussis, and Varicella. Recommended ages and doses will vary.
• Obesity screening and counseling – recommended for all overweight adults.
• Sexually transmitted infection prevention counseling – recommended for all adults at higher risk of contracting an STI such as chlamydia, gonorrhea and syphilis.
• Tobacco use screening and cessation interventions – recommended to all adults who use any form of tobacco product.

Free preventive services exclusively for women

• Anemia screening – a simple blood test recommended on a routine basis for all pregnant women.
• Breast cancer services — includes mammograms every one to two years for all women over 40, chemoprevention counseling for women at higher risk and genetic test counseling for women at high risk.
• Breastfeeding support and counseling – recommended for pregnant and nursing mothers. Includes access to breastfeeding supplies.
• Cervical cancer screening – a simple test recommended for all sexually active women.
• Contraception – covers FDA-approved contraceptive methods, sterilization procedures, education and counseling for women with reproductive capacity. Does not include abortifacient drugs and is not covered by plans sponsored by certain employer-provided plans that are exempt for First Amendment-protected religious reasons.
• Domestic and interpersonal violence screening and counseling – available to all women in at-risk situations.
• Folic acid supplements – available to any woman who may become pregnant.
• Gestational diabetes screening – recommended for women 24 to 28 weeks pregnant, and any woman at high risk of developing diabetes during pregnancy.
• Osteoporosis screening – recommended for most post-menopausal women to detect and halt bone loss.
• Rh incompatibility screening – a blood test recommended for all pregnant women, with follow-up testing for women at higher risk.
• Urinary tract and other infection screening – recommended for all pregnant women.
• Well-woman visits – an annual visit with a doctor or nurse that includes a full check-up and any necessary services, screenings and counseling. Recommended for all women to document health.

Minor children are also entitled to a number of preventive services not covered in this article.

Do you need ACA-compliant health insurance? Learn more about Open Enrollment, Special Enrollment and Short-Term policies and get online quotes here.