What Preventive Services are Covered by Obamacare?

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 status may not include these “free” preventive services.
• You should always confirm your health benefits with your health insurance plan.

Visit www.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.