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What Preventive Services are Covered by Obamacare?

What Preventive Services are Covered by Obamacare?

Posted May 28, 2014 by Author

Free preventive healthcare is often touted as a key Obamacare feature. Under the Affordable Care Act, non-grandfathered health insurance plans are required to cover certain preventive services at no additional cost to insured individuals.

Why the strong emphasis on preventive care?  

Chronic disease and conditions such as heart disease, stroke, cancer, diabetes, obesity and arthritis are among the most common, costly and preventable of all health problems in America, according to the Centers for Disease Control and Prevention.1 Chronic diseases account for 86 percent of our nation’s healthcare costs and are the leading cause of death and disability.2,3 
 

Yet, as the CDC states, many of these chronic conditions are preventable and even treatable (and often less expensive to treat) when detected early.4 A study led by the National Commission on Prevention Priorities found that preventive services such as daily aspirin use, tobacco cessation support and alcohol abuse screening can potentially save 2 million lives and nearly $4 billion annually.5 Furthermore, the research concluded that if 90 percent of the population had access to the three aforementioned preventive services and colorectal cancer screening, “the four interventions alone would result in more than 100,000 years of life saved.” 

Obamacare and preventive medicine 

The Affordable Care Act signed into law on March 23, 2010, was intended to help make healthcare, including preventive care, more affordable and accessible to all Americans.6 The law currently includes 66 no-cost preventive services (e.g., screenings, counseling, and immunizations) for men, women and children insured by non-grandfathered, ACA-compliant health insurance plans. 

Adults and preventive care 

There are 18 covered preventive services for adults with ACA-compliant health insurance plans. These services include the following7

  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 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. Hepatitis B screening for people at high risk 
  11. Hepatitis C screening for adults at increased risk and one time for those born between 1945 and 1965 
  12. HIV screening for everyone ages 15 to 65, and other ages at increased risk 
  13. Immunization vaccines for adults—doses, recommended ages, and recommended populations vary: 
    • Hepatitis A 
    • Hepatitis B 
    • Herpes Zoster 
    • Human Papillomavirus 
    • Influenza (Flu Shot) 
    • Measles, Mumps, Rubella 
    • Meningococcal 
    • Pneumococcal 
    • Tetanus, Diphtheria, Pertussis 
    • Varicella 
  14. Lung cancer screening for adults ages 55 to 80 at high risk for lung cancer who are heavy smokers or have quit in the past 15 years* 
  15. Obesity screening and counseling for all adults 
  16. Sexually transmitted infection (STI) prevention counseling for adults at higher risk 
  17. Syphilis screening for all adults at higher risk 
  18. Tobacco Use screening for all adults and cessation interventions for tobacco users 

Women and preventive care 

The 22 covered preventive services for women, including pregnant women, took effect with plan years starting on or after Aug. 1, 2012.8 These services include the following9

  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, as prescribed by a health care provider for women with reproductive capacity (not including abortifacient drugs). This does not apply to health plans sponsored by certain exempt “religious employers.” 
  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 cytology 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 

Children and preventive care 

There are 26 covered preventive services for children with ACA-compliant health insurance plans. These services include the following10

  1. Alcohol and drug use assessments for adolescents 
  2. Autism screening for children at 18 and 24 months 
  3. Behavioral assessments for children at the following ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years 
  4. Blood Pressure screening for children at the following ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years 
  5. Cervical dysplasia screening for sexually active females 
  6. Depression screening for adolescents 
  7. Developmental screening for children under age 3 
  8. Dyslipidemia screening for children at higher risk of lipid disorders at the following ages: 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years 
  9. Fluoride Chemoprevention supplements for children without fluoride in their water source 
  10. Gonorrhea preventive medication for the eyes of all newborns 
  11. Hearing screening for all newborns 
  12. Height, weight and Body Mass Index measurements for children at the following ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years 
  13. Hematocrit or Hemoglobin screening for children 
  14. Hemoglobinopathies or sickle cell screening for newborns 
  15. HIV screening for adolescents at higher risk 
  16. Hypothyroidism screening for newborns 
  17. Immunization vaccines for children from birth to age 18—doses, recommended ages, and recommended populations vary: 
    • Diphtheria, tetanus, pertussis 
    • Haemophilus influenzae type B 
    • Hepatitis A 
    • Hepatitis B 
    • Human papillomavirus 
    • Inactivated poliovirus 
    • Influenza (flu shot) 
    • Measles, mumps, rubella 
    • Meningococcal 
    • Pneumococcal 
    • Rotavirus 
    • Varicella 
  18. Iron supplements for children ages 6 to 12 months at risk for anemia 
  19. Lead screening for children at risk of exposure 
  20. Medical History for all children throughout development at the following ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years 
  21. Obesity screening and counseling 
  22. Oral health risk assessment for young children Ages: 0 to 11 months, 1 to 4 years, 5 to 10 years 
  23. Phenylketonuria (PKU) screening for this genetic disorder in newborns 
  24. Sexually transmitted infection (STI) prevention counseling and screening for adolescents at higher risk 
  25. Tuberculin testing for children at higher risk of tuberculosis at the following ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years 
  26. Vision screening for all children 

For a more comprehensive explanation of each preventive care service listed, visit healthcare.gov/what-are-my-preventive-care-benefits and click on the links provided with each listed item. 

How ‘free’ preventive care works 

Health insurance plans that began on or after Sept. 23, 2010, and qualify as minimum essential coverage under Obamacare—both those sold on and away from the state-based and federally facilitated health insurance exchanges—must include the preventive services listed above at no additional cost to insured individuals.1 That means you cannot be charged a copayment or coinsurance for these services, even if you have not yet met your annual deductible.  

Keep in mind that: 

  • You must visit a network healthcare provider covered by your health insurance plan, so be sure to check your provider.  
  • Health insurance plans with grandfathered statusmay not include these “free” preventive services.  
  • You should always confirm your health benefits with your health insurance plan. 

Visit healthedeals.com to learn more about health insurance, the Affordable Care Act, and living a healthy lifestyle. While you are there, get quotes for supplemental health benefits such as dental insurance, telemedicine and gap benefits, which can help further reduce your out-of-pocket healthcare spending.  

Last updated Aug. 12, 2015


1U.S. Centers for Disease Control and Prevention. “Chronic Diseases and Health Promotion.” Last updated May 18, 2015. http://www.cdc.gov/chronicdisease/overview/index.htm  

2U.S. Centers for Disease Control and Prevention. “Chronic Disease Prevention and Health Promotion.” Last updated July 21, 2015.

3U.S. Centers for Disease Control and Prevention. “Chronic Diseases and Health Promotion.” Last updated May 18, 2015. http://www.cdc.gov/chronicdisease/overview/index.htm  

4Centers for Disease Control and Prevention. “Preventive Health Care.” Last updated June 12, 2013. http://www.cdc.gov/healthcommunication/toolstemplates/entertainmented/tips/preventivehealth.html

5Currie, Donya. “Prevention Saves Lives as Well as Money, New Research Confirms.” Nations Health. 2010; 40 (9). http://www.medscape.com/viewarticle/735245

6U.S. Department of Health and Human Services. “Affordable Care Act Rules on Expanding Access to Preventive Services for Women.” Last modified June 28, 2013http://www.hhs.gov/healthcare/facts/factsheets/2011/08/womensprevention08012011a.html

7HealthCare.gov. “What are My Preventive Health Benefits?: Preventive Health Services for Adults.” n.d. https://www.healthcare.gov/what-are-my-preventive-care-benefits/#part=1

8Ibid. 

9HealthCare.gov. “What are My Preventive Care Benefits?: Preventive Health Services for Women.” n.d. https://www.healthcare.gov/what-are-my-preventive-care-benefits/#part=2

10HealthCare.gov. “What are My Preventive Care Benefits?: Preventive Health Services for Children.” n.d. https://www.healthcare.gov/what-are-my-preventive-care-benefits/#part=3

11U.S. Department of Health and Human Services. “Affordable Care Act Rules on Expanding Access to Preventive Services for Women.” Last revised June 28, 2013. http://www.hhs.gov/healthcare/facts/factsheets/2011/08/womensprevention08012011a.html

About The IHC Group
The IHC Group is an organization of insurance carriers and marketing and administrative affiliates that has been providing life, health, disability, medical stop-loss and specialty insurance solutions to groups and individuals for over30 years. Members of The IHC Group include Independence Holding Company (NYSE:IHC), American IndependenceCorp. (NASDAQ: AMIC), Standard Security Life Insurance Company of New York, Madison National Life Insurance Company, Inc. and Independence American Insurance Company. Each insurance carrier in The IHC Group has a financial strength rating of A- (Excellent) from A.M. Best Company, Inc., a widely recognized rating agency that rates insurance companies on their relative financial strength and ability to meet policyholder obligations. (An A++ rating from A.M. Best is its highest rating.) Collectively, the companies in The IHC Group provide insurance coverage to more than one million individuals and groups. For more information about The IHC Group, visit www.ihcgroup.com.

About IHC Specialty Benefits, Inc.
IHC Specialty Benefits, doing business as Health eDeals Insurance Solutions is a full-service marketing and distribution company that focuses on small employer, individual and consumer products. Health eDeals markets products through general agents online, telebrokerage, advisor centers, private label and directly to consumers. For more information about Health eDeals visit www.HealtheDeals.com.