What free preventative services does my health insurance provide?

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What free preventative services does my health insurance provide?

Did you know that thanks to the Affordable Care Act, your health insurance plan comes with a ton of free stuff? I don’t mean free stuff like pens, t-shirts, and Apple Watches (though you may also get those perks), I mean free stuff like critical preventative care that will help prevent and catch dangerous diseases before they develop.

Every health insurance plan should cover the same basic set of preventative services, which we’ll outline below. And when we say that your plan "should" cover these services, we mean it’s a federal law. Called Obamacare. You probably heard about it.

These preventative services will be covered whether you have a plan purchased from Healthcare.gov or your state marketplace, an employer’s plan, or an off-exchange plan purchased from a private marketplace.

Why you need preventative services

Most major medical conditions start small and then build up over time. The goal with preventative services is to either prevent the disease from ever starting – usually with a vaccination – or to catch it before it becomes life-threatening. Not only does preventative care keep people healthier, it also lowers the cost of their health care in the future. We call that a win-win.

Are preventative services really free?

According to the Affordable Care Act, all private health insurance plans (on-exchange, off-exchange, and employer-provided plans) must cover preventative services at no cost to the patient, even if they haven’t reached their yearly deductible. There are four broad categories of preventative services that this rule covers, according to the Kaiser Family Foundation:

  1. Evidence-based screenings and counseling
  2. Routine immunizations
  3. Preventative services for children and youth
  4. Preventative services for women

We’ll go into more detail about what exact services are included under each of these categories below.

While health insurance companies may not charge a copayment, coinsurance, or deductible on preventive services, they do have some leeway when it comes to charging for office visits. According to the Kaiser Family Foundation, your insurer may charge a copayment or implement another form of cost-sharing in a few situations:

  • If the office visit and preventative service appear as separate line items on your bill, your insurer can charge you for the office visit
  • If you receive a preventative service, but it was not the primary reason for visiting the office, you may be charged for the office visit
  • If you received the preventative service from an out-of-network provider, but an in-network provider could have provided the service, you may be charged for both the office visit and the preventative service
  • If you receive treatment as a result of the preventative service, you may be charged for the treatment

In most cases, these caveats are reasonable; the most important thing to remember is that you may have to pay for the office visit if you go in for a preventive service. You will not be charged for the preventative service itself, however.

How to take advantage of preventative services

Your best bet for taking advantage of preventative services is to ask your doctor about what services are available and most appropriate to you during your yearly physical. Make sure you remind them that you want to be notified if a service or test is not free, and that tests should be processed by a lab in your health insurance network. If your doctor recommends screenings that are not free, discuss with them the potential benefits and cost of the service.

Preventative services for all adults

This list represents the specific preventative services available for all adults. It is sourced directly from Healthcare.gov.

  1. Abdominal aortic aneurysm one-time screening (Healthcare.gov notes that this is limited to "men of specific ages who have ever smoked")
  2. Alcohol misuse screening and counseling
  3. Aspirin use (specifically to "prevent cardiovascular disease for men and women of certain ages")
  4. Blood pressure screening
  5. Cholesterol screening
  6. Colorectal cancer screening (only available for adults older than 50)
  7. Depression screening
  8. Diabetes (Type 2) screening (limited to adults with high blood pressure)
  9. Diet counseling (limited to adults "at higher risk for chronic disease")
  10. Hepatitis B screening
  11. Hepatitis C screening
  12. HIV screening (available between the ages of 15 to 65)
  13. Lung cancer screening (for smokers and past smokers between the ages of 55 and 80)
  14. Obesity screening and counseling
  15. Sexually transmitted infection prevention counseling
  16. Syphilis screening
  17. Tobacco use screening and cessation interventions for tobacco users

The following immunization vaccines are also covered:

  1. Diphtheria
  2. Hepatitis A
  3. Hepatitis B
  4. Herpes Zoster
  5. Human Papillomavirus (HPV)
  6. Influenza (flu shot)
  7. Measles
  8. Meningococcal
  9. Mumps
  10. Pertussis
  11. Pneumococcal
  12. Rubella
  13. Tetanus
  14. Varicella (chickenpox)

Preventative services for women

This list represents the specific preventative services available for all adult women. It is sourced directly from Healthcare.gov.

  1. Breast cancer genetic test counseling
  2. Breast cancer mammography screenings ("every 1 to 2 years for women over 40")
  3. Breast cancer chemoprevention counseling
  4. Cervical cancer screening
  5. Chlamydia infection screening
  6. Domestic and interpersonal violence screening and counseling
  7. Gonorrhea screening
  8. HIV screening and counseling
  9. Human Papillomavirus (HPV) DNA test ("every 3 years for women with normal cytology results who are 30 or older")
  10. Osteoporosis screening (available above the age of 60)
  11. Rh incompatibility screening
  12. Sexually transmitted infections counseling
  13. Syphilis screening
  14. Tobacco use screening and interventions
  15. Well-woman visits

Preventative services for pregnant women or women who may become pregnant

This list represents the specific preventative services available for pregnant women and women who may become pregnant. It is sourced directly from Healthcare.gov.

  1. Anemia screening
  2. Breastfeeding comprehensive support and counseling and access to breastfeeding supplies
  3. Contraception (does not apply to plans sponsored by exempt "religious employers.")
  4. Folic acid supplements
  5. Gestational diabetes screening ("for women 24 to 28 weeks pregnant")
  6. Gonorrhea screening
  7. Hepatitis B screening (at your first prenatal visit)
  8. Rh Incompatibility screening
  9. Syphilis screening
  10. Expanded tobacco intervention and counseling
  11. Urinary tract infection screening

Preventative services for children

This list represents the specific preventative services available for all children and youth. It is sourced directly from Healthcare.gov. Some services are only available to children and youth of a certain age.

  1. Alcohol and drug use assessments
  2. Autism screening (at 18 and 24 months)
  3. Behavior assessments
  4. Blood pressure screening
  5. Cervical dysplasia screening ("for sexually active females")
  6. Depression screening
  7. Developmental screening (under the age of 3)
  8. Dyslipidemia screening (starting at age 1, "for children at higher risk of lipid disorders")
  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 (newborns)
  12. Height, weight, and body mass index (BMI) measurements
  13. Hematocrit or hemoglobin screening
  14. Hemoglobinopathies or sickle cell screening (newborns)
  15. Hepatitis B screening
  16. HIV screening
  17. Hypothyroidism screening (newborns)
  18. Iron supplements (age 6 to 12 months, "for children… at risk for anemia")
  19. Lead screening
  20. Medical history for all children throughout development ages
  21. Obesity screening and counseling
  22. Oral health risk assessment for young children (0 to 10 years)
  23. Phenylketonuria (PKU) screening
  24. Sexually transmitted infection (STI) prevention counseling and screening
  25. Tuberculin testing for children at higher risk of tuberculosis
  26. Vision screening

The following immunizations are also covered:

  1. Diphtheria, tetanus, pertussis (whooping cough)
  2. Haemophilus influenzae type b
  3. Hepatitis A
  4. Hepatitis B
  5. Human Papillomavirus (HPV)
  6. Inactivate Poliovirus
  7. Influenza (flu shot)
  8. Measles
  9. Meningococcal
  10. Pneumococcal
  11. Rotavirus
  12. Varicella (chickenpox)

Learn more about your health insurance benefits

To learn more about the benefits of having health insurance, check out our health insurance guide. While preventative care may be free, health insurance isn’t, so make sure you’re making the most of your plan.