What Preventive Care is Covered by the ACA?

Cathy Jakicic
November 12th, 2019 September 5th, 2019 |
Read time: 19 minutes

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Free preventive care is considered a key feature of the Affordable Care Act (ACA, also known as Obamacare). Under the ACA, policies purchased after the law was signed (March 23, 2010) must cover certain preventive services at no additional cost to insured individuals.

One exception: If you have a grandfathered policy that’s still in effect, it may not cover some or all of these preventive services.

Learn more about grandfathered major medical policies.

So, what is preventive care? It’s the care (including screening and counseling) you receive to prevent illnesses or diseases.

Learn more about why preventive care is important and how ACA preventive care benefits work below.

Or jump right to the list of preventive care services covered by ACA health plans.

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Why are preventive care services important?

Chronic diseases are among the most common and costly health conditions in the United States. Chronic diseases, such as heart disease, cancer, and diabetes are responsible for seven of every 10 deaths among Americans each year and account for 75% of the nation’s health spending.1

A study led by the National Commission on Prevention Priorities found that if 90% of the population had access to just daily aspirin use, tobacco cessation support, alcohol abuse screening and colorectal cancer screening, it would potentially save 2 million lives and nearly $4 billion annually.2

But despite these numbers, the Centers for Disease Control and Prevention reported that Americans use preventive services about half as often as they should.3

Before the ACA requirements, even people with insurance may have skipped preventive healthcare services because of copayments and deductibles.4

By eliminating the deductibles, coinsurance, or copayments associated with the covered preventive services, the ACA may be increasing the likelihood that these services will be used.5

How “free” ACA preventive care services work

As we said earlier, a health insurance policy that began on or after Sept. 23, 2010, and qualifies as minimum essential coverage under the ACA must include the preventive services listed below at no additional cost.

Keep in mind, generally:

  • You must visit an in-network healthcare provider covered by your health insurance policy, so be sure to check with your provider or insurance carrier.6
  • Your doctor may provide a preventive service, such as a cholesterol screening test, as part of an office visit. Your policy can require you to pay some costs of the office visit, if the preventive service is not the primary purpose of the visit, or if your doctor bills you for the preventive services separately from the office visit.7
  • If you have a grandfathered health insurance policy, it  may not include these free preventive services.

Do you need ACA health insurance?

If you want to take advantage of preventive healthcare services and need individual ACA-qualifying major medical insurance, you must either qualify for a special enrollment period or enroll during the annual open enrollment period (Nov – Dec). Find out if you qualify for special enrollment.

Remember, you may be able to get help paying for your coverage through a federal subsidy if you qualify and you enroll through the federal marketplace or your state’s exchange.

Do You Qualify for an Affordable Care Act Subsidy?

Use the ACA Subsidy Calculator to find out if you can get financial help if you enroll in ACA-qualifying major medical insurance. Learn more about subsidies.

What if you don’t want preventive care benefits?

If you can’t afford ACA-compliant major medical insurance, don’t think you’ll use the covered preventive services, or just prefer to pay for routine healthcare out of pocket, you may want to consider a short term health insurance policy.

Short term policies typically do not cover preventive care. They are meant to be temporary coverage for critical illnesses or accidents and often cover:

  • Hospital room and board
  • Emergency room treatment
  • Surgical services
  • Ambulance services

Short term insurance provides limited benefits when compared to major medical, but premiums may be lower as a result.

Short term medical policies are not ACA-compliant. They are not guaranteed-issue (meaning that you must qualify for coverage), do not usually cover pre-existing conditions and include few, if any, essential health benefits. However, you can apply anytime during the year and your coverage can begin the next day if you qualify.

The best way to find plan options available to you and compare costs is to get a quote (it just takes a minute).

Get a Quote – Short Term Medical Insurance

ACA-covered preventive services for adults

There are 21 covered preventive health services for adults with ACA-compliant health insurance policies. These services include the following:8

Abdominal aortic aneurysm – one-time screening for men of specified ages who have ever smoked. Aneurysms can grow slowly without any symptoms. When an aneurysm is large enough to burst, it can be potentially fatal.9

Learn more about abdominal aortic aneurysms and if you could be at risk.

Alcohol misuse screening and counseling. If you think alcohol misuse may be an issue, it’s a good idea to get more information.10

Find out if you may be at risk.

Aspirin to prevent cardiovascular disease and colorectal cancer for adults 50 to 59 years with a high cardiovascular risk. Ask your doctor about taking aspirin regularly if you smoke, have high blood pressure, high cholesterol, or diabetes.11

Should you be on an aspirin regimen to help prevent disease? Learn more.

Blood pressure screening. One in three American adults has high blood pressure. Having high blood pressure increases your risk for serious health problems, including strokes and heart attacks.12

Learn more about when to check your blood pressure and who is at risk for elevated blood pressure.

Cholesterol screening for adults of certain ages or at higher risk. It is usually recommended that you get your cholesterol checked every four to six years. If you’re at higher risk – if high cholesterol runs in your family, for instance – you may need to get it checked more often.13

Learn more about cholesterol screenings and who is at a higher risk for elevated cholesterol.

Colorectal cancer screening for adults 50 to 75. Finding colorectal cancer early may make it easier to treat. You may need to get tested before age 50 if colorectal cancer runs in your family.14

Learn more about colorectal cancer and if you’re at risk.

Depression screening. Depression affects millions of adults in the United States every year and it can be treated.15

Learn more about depression, including the symptoms and treatment options available.

Diabetes (Type 2) screening for adults 40 to 70 years who are overweight or obese. Diabetes can increase the risk of serious health problems, including heart disease, kidney failure, and blindness.16

Learn more about type 2 diabetes, risk factors, symptoms and prevention.

Diet counseling for adults at higher risk for chronic disease. A healthy eating pattern can help avoid a number of serious conditions that may result from a poor diet.17

Learn more about healthy eating.

Falls prevention (with exercise or physical therapy and vitamin D use) for adults 65 years and over, living in a community setting. According to the National Institute for Aging, more than one in three people age 65 years or older falls each year. The risk rises with age.18

Hepatitis B screening for people at high risk. If you’re from a country with 2% or more Hepatitis B prevalence, born in the U.S., but not vaccinated as an infant, or have at least one parent born in a region with 8% or more Hepatitis B prevalence, you’re considered high risk.19

Hepatitis C screening for adults at increased risk, and one time for everyone born 1945-1965. Many people who have hepatitis C live for years without symptoms, but the virus can still damage your liver or you could spread the virus to others without knowing it.20

Learn more about the risk factors for Hep C and when to talk to your doctor.

HIV screening for everyone ages 15 to 65, and other ages at increased risk. The only way to know if you have HIV is to get tested.21

Learn more about HIV: risk factors, prevention and testing.

Immunization vaccines for adults.22 For doses, recommended ages and populations, check vaccines.gov.

  • Diphtheria
  • Hepatitis A
  • Hepatitis B
  • Herpes Zoster
  • Human Papillomavirus (HPV)
  • Influenza (flu shot)
  • Measles
  • Meningococcal
  • Mumps
  • Pertussis
  • Pneumococcal
  • Rubella
  • Tetanus
  • Varicella (Chickenpox)

Lung cancer screening for adults 55-80 at high risk. If you’re a heavy smoker or have quit in the last 15 years, you’re considered at a higher risk for lung cancer.23

Obesity screening and counseling. If you are overweight or obese and have risk factors for heart disease (like high blood pressure or high cholesterol) counseling can help with establishing healthy eating and physical activity habits.24

Find out if you could benefit from obesity screening and counseling.

Sexually transmitted infection (STI) prevention counseling for adults at higher risk. Many people with STIs don’t have signs or symptoms. The only way to know is to get tested.25

Statin preventive medication for adults 40 to 75 at high risk. Experts recommend that you take a statin if you are age 40 to 75, have high cholesterol, diabetes, high blood pressure, or you smoke.26

Learn more about medications to prevent heart attack and if you should consider taking one.

Syphilis screening for adults at higher risk. Some people who contract syphilis notice symptoms soon after they get it, but many people don’t have signs or symptoms. The only way to know for sure if you have this sexually transmitted disease is to get tested.27

Learn more about syphilis risk factors and testing.

Tobacco use screening for all adults and cessation interventions for tobacco users. Smoking is the leading cause of preventable death and disease in the United States. The sooner you quit, the sooner your body can start to heal.28

Learn more about the risks of smoking and the benefits of quitting.

Tuberculosis (TB) screening for certain adults without symptoms at high risk. You can have TB and not feel sick, so it’s important to get tested. You are considered high risk if you were born in or have lived in a country where TB is common – for example, Mexico, the Philippines, Vietnam, India, or China. Or if you live or have lived in a large group setting – for example, a homeless shelter or a prison, or have HIV or another condition that weakens your immune system.29

Learn more about how to speak with your doctor about TB.

What about dental and vision benefits for adults?

Dental and vision care are not included in the preventative health benefits for adults (though they are for children under 18). A separate dental policy hay help with out-of-pocket costs for routine cleanings, fillings and extractions. And premiums and deductibles are typically affordable.

Get a Dental Insurance Quote

ACA-covered preventive services for women

These 23 covered preventive services for women took effect with plan years starting on or after Aug. 1, 2012. These services include the following:30

Routine anemia screening. The U.S. Preventive Services Task Force recommends routine screening for iron deficiency anemia in asymptomatic pregnant women.31 Getting prenatal care, including anemia screening, lowers the risk of your baby being born too early, which can lead to health problems.32

Learn more about how to have a healthy pregnancy.

Breast cancer genetic test counseling (BRCA) for women at higher risk. Genetic counseling and testing can help you understand your risk for some cancers that may run in families.33

Learn more about breast and ovarian cancer risk factors and genetic testing.

Breast cancer mammography screenings every 1 to 2 years for women over 40. Mammograms can help find breast cancer early. Most women can survive breast cancer if it’s found and treated early.34

Learn more about breast cancer risk factors, symptoms and mammograms.

Breast cancer chemoprevention counseling for women at higher risk. Preventive medications (chemoprevention) reduce breast cancer risk in women at high risk of developing the disease.35

Learn more about chemoprevention, including how it works and who it’s for.

Breastfeeding comprehensive support and counseling from trained providers, access to breastfeeding supplies, for pregnant and nursing women. Breastfeeding is natural, but that doesn’t mean it’s always easy. Almost all moms need a little help.36

Learn more about the benefits of breastfeeding and how to get help.

Cervical cancer screening. A Pap smear is covered every three years for women ages 21 to 65. A human papillomavirus (HPV) DNA test with the combination of a Pap smear is covered every five years for women ages 30 to 65 who don’t want a Pap smear every three years.37

Testing can help find cervical cells that are infected with HPV or other abnormal cells before they turn into cancer. Most cervical cancers can be prevented by regular screenings – and the right follow-up treatment when needed.38

Learn more about cervical cancer screenings and how often you should get one.

Chlamydia infection screening for younger women and other women at higher risk. Chlamydia can be cured with the right treatment, but it not treated can cause serious health problems, like making it difficult or impossible for a woman to get pregnant.39

Learn more about Chlamydia risk factors, testing and treatment.

Contraception: Food and Drug Administration-approved contraceptives, sterilization and patient education and counseling, as prescribed by a healthcare provider (not including abortion drugs). Coverage does not apply to health policies sponsored by certain exempt “religious employers.”40

Diabetes screening for women with a history of gestational diabetes who aren’t currently pregnant and who haven’t been diagnosed with type 2 diabetes. Diabetes can increases the risk of serious health problems, including heart disease, kidney failure and blindness.41

Learn more about the risk factors for gestational diabetes, testing and prevention.

Domestic and interpersonal violence screening and counseling for all women. If your partner is controlling or abusive, it’s better to get help right away.42

Learn more about the signs of domestic violence and if you know you need help, contact the National Domestic Violence Hotline (1-800-799-7233).

Folic acid supplements for women who may become pregnant. Everyone needs folic acid, but it’s especially important if you are pregnant or may become pregnant. Folic acid is a vitamin that can prevent birth defects.43

Learn about why folic acid is important and how to get enough of it.

Gestational diabetes screening for women 24 to 28 weeks pregnant and those at high risk of developing gestational diabetes. If you develop gestational diabetes, it can lead to health problems for you and your baby during and after pregnancy.44

Learn more about risk factors and gestational diabetes screening.

Gonorrhea screening for all women at higher risk. Gonorrhea can be cured with the right treatment, but it not treated can cause serious health problems, such as making it difficult or impossible for a woman to get pregnant.45

Learn more about Gonorrhea risk factors and screening.

Hepatitis B screening for pregnant women at their first prenatal visit. Getting prenatal care can help you have a healthier baby.46 If you are from a country with 2% or more Hepatitis B prevalence, born in the U.S. but not vaccinated as an infant, or have at least one parent born in a region with 8% or more Hepatitis B prevalence, you’re considered high risk.47

HIV screening and counseling for sexually active women. The only way to know if you have HIV is to get tested.48

Learn more about HIV risk factors and testing.

Osteoporosis screening for women over age 60 depending on risk factors. There are no signs or symptoms of osteoporosis. You might not know you have the disease until you break a bone.49

Learn more about risk factors for osteoporosis and screening.

Preeclampsia prevention and screening for pregnant women with high blood pressure. Many women who have preeclampsia don’t feel sick. The main sign of preeclampsia is high blood pressure. It’s important to get regular checkups during pregnancy so your doctor or midwife can check your blood pressure.50

Learn more about preeclampsia, risk factors and prevention.

Rh incompatibility screening for all pregnant women and follow-up testing for women at higher risk. Rh incompatibility occurs during pregnancy if a woman has Rh-negative blood and her baby has Rh-positive blood. If you’re Rh-negative and your baby is Rh-positive, your body will react to the baby’s blood as a foreign substance.51

Sexually transmitted infections counseling for sexually active women. Many people with STIs don’t have signs or symptoms. The only way to know is to get tested.52

Syphilis screening. Some people who get syphilis notice symptoms soon after they get it, but many people don’t have signs or symptoms. The only way to know if you have syphilis is to get tested.53

Learn more about syphilis risk factors and testing.

Expanded tobacco intervention and counseling for pregnant tobacco users. Smoking is the leading cause of preventable death and disease in the United States and can cause pregnancy problems. The sooner you quit, the sooner your body can start to heal.54

Learn more about the risks of smoking and the benefits of quitting.

Urinary tract or other infection screening for pregnant women. Screenings to identify infections like UTIs early may make them easier to treat.55

Well-woman visits to get recommended services for women under 65. Well-woman visits include a full checkup, separate from any other visit for sickness or injury. Services like shots and screenings can help prevent diseases and other health problems.56

Learn more about what a well-woman doctor’s visit is and how it may be able to help you.

ACA-covered preventive services for children

There are 31 ACA-covered preventive services for children with ACA-compliant health insurance policies. The ACA defines “child” as anyone 17 and under.57

As with the covered services for adults, catching potential problems early can help keep kids healthy and thriving. The list of covered services for children that is included here is also available at Healthcare.gov. These services include:58

Alcohol and drug use assessments for adolescents.

Autism screening  for children at 18 and 24 months.

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.

Bilirubin concentration screening for newborns. Testing for bilirubin in the blood can be a good way of testing for liver damage. Mild jaundice in newborns can be the first sign of a medical problem.59

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.

Blood screening for newborns. The blood test is generally performed when a baby is 24 to 48 hours old. Certain conditions may go undetected if the blood sample is drawn before that.

A newborn screening does not confirm a baby has a certain condition. But if a positive screen is detected, parents will be notified and follow-up testing will be done.60

Cervical dysplasia screening for sexually active girls.

Depression screening for adolescents beginning routinely at age 12.

Developmental screening for children under age 3.

Dyslipidemia screening for all children once between 9 and 11 years and once between 17 and 21 years, and for children at higher risk of lipid disorders ages: 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years. Dyslipidemias can result in unhealthy cholesterol and triglyceride levels.61

Fluoride chemoprevention supplements for children without fluoride in their water source.

Fluoride varnish for all infants and children as soon as teeth are present.

Gonorrhea preventive medication for the eyes of all newborns. Babies born to mothers with gonorrhea can receive a medication in their eyes soon after birth to prevent infection.62

Hearing screening for all newborns; and for children once between 11 and 14 years, once between 15 and 17 years, and once between 18 and 21 years.

Height, weight and Body Mass Index (BMI) 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.

Hematocrit or Hemoglobin screening for all children to screen for anemia.63

Hemoglobinopathies (a group of blood disorders and diseases that affect red blood cells) or sickle cell screening for newborns.64

Hepatitis B screening for adolescents at high risk. Adolescents from countries with 2% or more Hepatitis B prevalence, and U.S.-born adolescents not vaccinated as infants and with at least one parent born in a region with 8% or more Hepatitis B prevalence: 11–17 years are considered high risk.65

HIV screening for adolescents at higher risk.

Hypothyroidism screening for newborns.

Immunization vaccines for children from birth to age 18. For doses, recommended ages and populations, check vaccines.gov.

  • Diphtheria, tetanus, pertussis (whooping cough)
  • Haemophilus influenzae type B
  • Hepatitis A
  • Hepatitis B
  • Human papillomavirus
  • Inactivated poliovirus
  • Influenza (flu shot)
  • Measles
  • Meningococcal
  • Pneumococcal
  • Rotavirus
  • Varicella (chickenpox)

Iron supplements for children ages 6 to 12 months at risk for anemia.

Lead screening for children at risk of exposure.

Maternal depression screening for mothers of infants at 1-, 2-, 4-, and 6-month visits.

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.

Obesity screening and counseling.

Oral health risk assessment for young children. Ages: 0 to 11 months, 1 to 4 years, 5 to 10 years.

Phenylketonuria (PKU) screening for the genetic disorder in newborns. Phenylketonuria causes an amino acid (phenylalanine) to build up in the body. Without the enzyme necessary to process phenylalanine, a dangerous buildup can develop when a person eats foods that contain protein or aspartame. This can eventually lead to serious health problems.66

Sexually transmitted infection (STI) prevention counseling and screening for adolescents at higher risk

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.

Vision screening for all children.

Coverage for the Whole Family

Insurance for just you, a child, or the whole family? Get the coverage you need. Call 888-855-6837 to speak to an insurance agent for help understanding your options.

Or, get started by finding options available in your state.

Summary + Next Steps

ACA health plans cover a range of preventive healthcare services for men, women and kids.

Using these services may help you stay healthier and catch health problems before they become more serious.

Visit healthcare.gov to learn more about the individual preventive care benefits.

If you don’t have an ACA-qualifying major medical plan and aren’t able to obtain one until the next open enrollment period, don’t go completely uninsured in the meantime.

Even though they don’t cover preventive care, you can apply for a non-ACA short term health plan to help with out of pocket costs for accidents and illnesses that result in hospitalization, surgery, or a trip to the ER. These plans are available year-round and premiums are typically lower than major medical plans because they provide less coverage.

If you qualify, you can begin coverage as soon as the next day.

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Originally Published On May 28th, 2014
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Footnotes

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Open enrollment is Nov. 1 to Dec. 15, 2019 in most states. Find out if you could qualify for an ACA subsidy.

 

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