Most health insurance plans offer free, preventive wellness visits, screenings, counseling and other services through in-network providers.
The Affordable Care Act mandates that private individual and group health insurance plans provide certain preventive coverage. Most cover blood pressure and breast cancer screenings, mammography, immunizations recommended by the Centers for Disease Control (including flu shots) and wellness visits. Often, these services are available to consumers without a copayment or coinsurance, even if they haven’t met their yearly deductible, as long as they receive them from a provider in their plan’s network.
Learn about the 10 essential health benefits every plan covers.
Short-term health plans, health sharing ministries and other “alternative” health plans don't qualify as “health insurance” under the ACA, so those types of policies may not cover preventive services.
Consumers should research their health insurance policies to find out which services are included and ask their doctors about the recommended ages for the tests, as well as any possible risks or side effects.
Free, preventive services for adults offered through all marketplace plans and many other insurance plans include:
- 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 and colorectal cancer for adults 50 to 59 years with a high cardiovascular risk
- Blood pressure screening
- Cholesterol screening for adults of certain ages or at higher risk
- Colorectal cancer screening for adults 50 to 75
- Depression screening
- Diabetes (Type 2) screening for adults 40 to 70 years who are overweight or obese and obesity screening and counseling
- Diet counseling for adults at higher risk for chronic disease
- Falls prevention (with exercise or physical therapy and vitamin D use) for adults 65 years and older living in a community setting
- Hepatitis B screening for people at high risk, including people from countries with 2% or more Hepatitis B prevalence, and U.S.-born people not vaccinated as infants and with at least one parent born in a region with 8% or more Hepatitis B prevalence.
- Hepatitis C screening for adults at increased risk, and one time for everyone born between 1945 and 1965
- HIV screening for everyone ages 15 to 65, and other ages at increased risk
- Vaccines for diseases including Hepatitis A and B, measles, mumps, rubella, flu, HPV, tetanus and chickenpox.
- Lung cancer screening for adults 55 to 80 at high risk for lung cancer because they’re heavy smokers or have quit in the past 15 years
- Sexually transmitted infection prevention counseling for adults at higher risk
- Statin preventive medication, which reduces the risk of heart attack and stroke by helping to lower cholesterol levels, for adults 40 to 75 at high risk
- Syphilis screening for adults at higher risk
- Tobacco use screening for all adults and cessation interventions for tobacco users
- Tuberculosis screening for certain adults without symptoms at high risk
What services are covered for women?
For women, most health insurance plans should cover services including: breast cancer mammography screenings every one to two years for women over 40; cervical cancer screenings; domestic and interpersonal violence screening and counseling, HIV screening and counseling and wellness visits.
Women can receive free contraception, though plans provided by certain religious employers and organizations may be exempt. Women who could become pregnant can receive folic acid supplements. Gestational diabetes screening is available for women 24 to 28 weeks pregnant and those at high risk of developing gestational diabetes. Pregnant and nursing women can receive breastfeeding support and counseling.
What services are covered for children?
Baby and child wellness visits are covered and include height, weight, mobility and other development checks. Many plans also offer free autism screenings for children, depression screenings starting at age 12 and blood pressure screenings from newborn through age 17. Behavioral, alcohol, tobacco and drug use assessments for adolescents are free through ACA and many private plans.
Parents should also check their plans to see if screenings for dyslipidemia (high cholesterol in the blood) are covered for children, since high cholesterol is sometimes inherited. The ACA covers screenings for all children once between 9 and 11 years and once between 17 and 21 years, and more often for children at higher risk.
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