Many health plans are required to cover certain preventive care services to adults at no cost under the Affordable Care Act, such as mammograms and colonoscopies. All health plans sold through the health insurance marketplaces — where small businesses and consumers can shop for coverage come Oct. 1 — and many other plans must cover the following list of preventive services without charging you a copayment or coinsurance:
1. Abdominal aortic aneurysm one-time screening for men of specified ages who have ever smoked
2. Alcohol misuse screening and counseling
3. Aspirin use to prevent cardiovascular disease for men and women of certain ages
4. Blood pressure screening for all adults
5. Cholesterol screening for adults of certain ages or at higher risk
6. Colorectal cancer screening (colonoscopies) for adults over 50
7. Depression screening for adults
8. Diabetes (Type 2) screening for adults with high blood pressure
9. Diet counseling for adults at higher risk for chronic disease
10. HIV screening for everyone ages 15 to 65, and other ages at increased risk
11. Immunization for adults — doses, recommended ages, and recommended populations vary:
— Tetanus, Diphtheria, Pertussis
12. Obesity screening and counseling for all adults
13. Sexually Transmitted Infection prevention counseling for adults at higher risk
14. Syphilis screening for all adults at higher risk
15. Tobacco use screening for all adults and cessation interventions for tobacco users
Preventive health services for women
Most health plans must cover additional preventive health services for women. All marketplace health plans and many other plans must cover the following list of preventive services for women without charging a copayment or coinsurance:
1. Anemia screening on a routine basis for pregnant women
2. Breast Cancer Genetic Test Counseling (BRCA) for women at higher risk for breast cancer
3. Breast cancer mammography screenings every 1 to 2 years for women over 40
4. Breast cancer chemoprevention counseling for women at higher risk
5. Breastfeeding comprehensive support and counseling from trained providers, and access to breastfeeding supplies, for pregnant and nursing women
6. Cervical cancer screening for sexually active women
7. Chlamydia infection screening for younger women and other women at higher risk
8. Contraception: Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling; must be prescribed by a health-care provider for women of reproductive age (not including drugs that induce abortion). This does not apply to health plans sponsored by certain exempt “religious employers.” Plans are not required to cover all brands of birth control.
9. Domestic and interpersonal violence screening and counseling for all women
10. Folic acid supplements for women who may become pregnant
11. Gestational diabetes screening for women 24 to 28 weeks pregnant and those at high risk of developing gestational diabetes
12. Gonorrhea screening for all women at higher risk
13. Hepatitis B screening for pregnant women at their first prenatal visit
14. HIV screening and counseling for sexually active women
15. Human Papillomavirus (HPV) DNA Test every 3 years for women with normal urine test results who are 30 or older
16. Osteoporosis screening for women over age 60 depending on risk factors
17. Rh Incompatibility screening for all pregnant women and follow-up testing for women at higher risk
18. Sexually transmitted infections counseling for sexually active women
19. Syphilis screening for all pregnant women or other women at increased risk
20. Tobacco use screening and interventions for all women, and expanded counseling for pregnant tobacco users
21. Urinary tract or other infection screening for pregnant women
22. Well-woman visits to get recommended services for women under 65
Source: HealthCare.gov
The required preventive benefits include services found to be effective by the U.S. Preventive Services Task Force ; immunizations endorsed by the U.S. Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices; pediatric services recommend by U.S. Health Resources and Services Administration ’s Bright Futures for Children program.
