No Cost-Sharing on Essential Preventive Care Thanks to the Affordable Care Act
ObamaCare includes preventive care at no out-of-pocket cost on most health plans. ObamaCare’s free preventive services help to put the focus on wellness, early detection, and prevention, instead of treatments and cures.
What Preventive Services are Covered Under ObamaCare?
Preventive care covers everything from immunizations, shots, screenings and tests. You’ll also get a free annual wellness visit on all major medical which can be used to facilitate preventive care. We have a full list of services below.
What Part of Preventive Services isn’t Covered Under ObamaCare?
For most preventive services, only the screening or vaccination itself is covered at no charge. The actual services required to facilitate preventive care can be subject to cost-sharing, and that is based on what plan you have. It’s important to check with your plan before assuming everything related to preventive care will be covered. Learn more about exactly what is covered at no cost sharing.
This is Preventive Care: Preventive care focuses on evaluating your current health status when you are symptom-free. Preventive care allows you to obtain early diagnosis and treatment, to help avoid more serious health problems. Through a preventive exam and routine health screenings, your doctor can determine your current health status and detect early warning signs of more serious problems. Your preventive care services may include immunizations, physical exams, lab work, and x-rays. During your preventive visit, your doctor will determine what tests or health screenings are right for you based on many factors such as your age, gender, overall health status, personal health history, and your current health condition.
This isn’t Preventive Care: Medical treatment for specific health conditions, on-going care, lab or other tests necessary to manage or treat a medical issue or health condition are considered diagnostic care or treatment, not preventive care.
TIP: In order to get your free annual wellness visit, you have to make sure your doctor codes it correctly. You can generally ask your doctor and insurer what each service will be coded as. This allows you to find out if a service will be billed as preventive care or not.
Learn more about preventive care in detail from this preventive care guide from UnitedHealthcare.
How to Make Sure Preventive Services are Coded Correctly
To ensure a preventive service is covered your doctor will need to bill the insurance company with the correct preventative code. If you have a history of problems, then a specific related service may not be covered by wellness/preventative benefits. If you get a claim denied you still have options. You can have your doctor recode, you can appeal, or you can simply call the insurer with a copy of your health insurance policy on hand. If you are unsure of how something will be coded you can always check with your insurer and your doctor beforehand you receive the treatment.
Why Cover Preventive Services?
Waiting to treat illness until a person is sick, instead of focusing on prevention, has had a direct effect on the rising health care costs in the U.S. Many Americans put off seeing a doctor until it’s too late due to cost. By making key preventive services free it helps Americans stay healthy. A doctor shouldn’t be someone to see only when you’re sick. Doctors also provide services that help keep you healthy.
Though It Would Save Insurers Money They Frequently Would Not Cover Disease Prevention Exams
Since health insurance became a routine benefit of employment, amazingly the insurance companies did not often cover preventative exams or tests. Over time, more insurers have begun offering a smattering of preventive coverage. But, to the insured, it was frequently very expensive until the insured reached the plan deductible. For the past few decades, deductibles and premiums rose quickly, and when hard economic times hit, people sought lower premiums that pushed their deductibles up. Once again, preventive health was on the back burner and the pilot light was out. For the uninsured, caring for a cold was challenging enough, preventive exams were a luxury that most could not afford.
Am I Eligible For ObamaCare’s Free Preventive Care?
Under ObamaCare, most health plans are required to cover certain preventive care services at no out-of-pocket costs. These services don’t require you to meet your deductible or other limits and should have no copay or coinsurance. If you are on a plan that doesn’t cover essential health benefits and free preventive services check out your state’s Health Insurance Marketplace to see if there is a better plan for you.
You may be eligible for free preventive screenings, like blood pressure and cholesterol tests, mammograms, colonoscopies, and more. This includes coverage for vaccines and new preventive services for women.
Obama Care Revives and Expands Preventive Health
Some of the first benefits that the American public received under the Affordable Care Act went into effect on September 23, 2010. The Affordable Care Act required that all major medical health insurance policies that went into effect on that day or afterward had to cover certain preventive services. In addition, these 15 services could not have any cost-sharing. No cost-sharing simply means no out-of-pocket payments and no need to wait until to reach a deductible.
What Types of Preventive Care Does ObamaCare Cover?
While adults get 15 services covered for preventive care, women get 22, and kids get 26 covered services. These services include some of the most important types of prevention like immunizations, mammograms, and wellness visits. Medicare patients also gain some new benefits under the ACA as the 2010 preventive health mandates apply to them as well.
Included in the 15 preventive services for adults are immunizations, screenings for depression, blood pressure, colorectal cancer, and high cholesterol. Diet and alcohol abuse counseling, though not screening services are also included as no out-of-pocket services.
Children are entitled to 26 preventive services. These include a host of developmental and other screenings and immunizations.
- 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
- 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:
- 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’s Preventive Services ObamaCare
In 2012, women became entitled to benefits under specific provisions of the Affordable Care Act. These provisions include well-woman visits, counseling for domestic violence victims, domestic violence screenings, and contraception counseling and dispensing.
- 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’s Preventive Services ObamaCare
- 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:
- 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.
Senior’s Preventive Services ObamaCare
- Abdominal aortic aneurysm screening
- Alcohol misuse screenings & counseling
- Bone mass measurements (bone density)
- Cardiovascular disease screenings
- Cardiovascular disease (behavioral therapy)
- Cervical & vaginal cancer screening
- Colorectal cancer screenings
- Depression screenings
- Diabetes screenings
- Diabetes self-management training
- Glaucoma tests
- Hepatitis C screening test
- HIV screening
- Mammograms (screening)
- Nutrition therapy services
- Obesity screenings & counseling
- One-time “Welcome to Medicare” preventive visit
- Prostate cancer screenings
- Sexually transmitted infections screening & counseling
- Tobacco use cessation counseling
- Yearly “Wellness” visit
More About the Affordable Care Act and Preventive Care
All plans starting January 1, 2014 or later feature these no-out-of-pocket preventive health exams.
Now that you understand some of the preventive care that is covered on new plans it’s time to go see if you qualify for cost assistance on a new marketplace plan or to learn more about ObamaCare’s new benefits, rights and protections.
Obamacare Free Preventive Care