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:
- Abdominal aortic aneurysm one-time screening for men of specified ages who have ever smoked
- Alcohol misuse screening and counseling
- Aspirin use to prevent cardiovascular disease for men and women of certain ages
- Blood pressure screening for all adults
- Cholesterol screening for adults of certain ages or at higher risk
- Colorectal cancer screening for adults over 50
- Depression screening for adults
- Diabetes (Type 2) screening for adults with high blood pressure
- Diet counseling for adults at higher risk for chronic disease
- Hepatitis B screening for people at high risk
- Hepatitis C screening for adults at increased risk and one time for those born between 1945 and 1965
- HIV screening for everyone ages 15 to 65, and other ages at increased risk
- 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
- 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*
- Obesity screening and counseling for all adults
- Sexually transmitted infection (STI) prevention counseling for adults at higher risk
- Syphilis screening for all adults at higher risk
- 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:
- Anemia screening on a routine basis for pregnant women
- Breast Cancer Genetic Test Counseling (BRCA) for women at higher risk for breast cancer
- Breast Cancer Mammography screenings every 1 to 2 years for women over 40
- Breast Cancer Chemoprevention counseling for women at higher risk
- Breastfeeding comprehensive support and counseling from trained providers, and access to breastfeeding supplies, for pregnant and nursing women
- Cervical Cancer screening for sexually active women
- Chlamydia Infection screening for younger women and other women at higher risk
- 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.”
- Domestic and interpersonal violence screening and counseling for all women
- Folic Acid supplements for women who may become pregnant
- Gestational diabetes screening for women 24 to 28 weeks pregnant and those at high risk of developing gestational diabetes
- Gonorrhea screening for all women at higher risk
- Hepatitis B screening for pregnant women at their first prenatal visit
- HIV screening and counseling for sexually active women
- Human Papillomavirus (HPV) DNA Test every 3 years for women with normal cytology results who are 30 or older
- Osteoporosis screening for women over age 60 depending on risk factors
- Rh Incompatibility screening for all pregnant women and follow-up testing for women at higher risk
- Sexually Transmitted Infections counseling for sexually active women
- Syphilis screening for all pregnant women or other women at increased risk
- Tobacco Use screening and interventions for all women, and expanded counseling for pregnant tobacco users
- Urinary tract or other infection screening for pregnant women
- 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:
- 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
- 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
- Cervical dysplasia screening for sexually active females
- Depression screening for adolescents
- Developmental screening for children under age 3
- 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
- Fluoride Chemoprevention supplements for children without fluoride in their water source
- Gonorrhea preventive medication for the eyes of all newborns
- Hearing screening for all newborns
- 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
- Hematocrit or Hemoglobin screening for children
- Hemoglobinopathies or sickle cell screening for newborns
- HIV screening for adolescents at higher risk
- Hypothyroidism screening for newborns
- 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
- Iron supplements for children ages 6 to 12 months at risk for anemia
- Lead screening for children at risk of exposure
- 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 this genetic disorder in newborns
- 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
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 status may 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.
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