Does health insurance cover preventive services?


Yes. A key provision of the Affordable Care Act (ACA) is the requirement that private insurance plans cover recommended preventive services without any patient cost-sharing. If you got a new health insurance plan or insurance policy on or after September 23, 2010, the following four broad categories of preventive services for adults and children must be covered without your having to pay a copayment or co-insurance or meet your deductible. This applies only when these services are delivered by an in-network provider.

Screenings and Counseling
Services required to be covered without cost-sharing include screening for depression, diabetes, cholesterol, obesity, various cancers, HIV, and sexually transmitted infections (STIs), as well as counseling for drug and tobacco use, healthy eating, and other common health concerns.

Routine Immunizations
Health plans must also provide coverage without cost-sharing for immunizations that are recommended and determined to be for routine use. These guidelines require coverage for adults and children and include immunizations such as influenza, meningitis, tetanus, HPV, hepatitis A and B, measles, mumps, rubella, and varicella.

Preventive Services for Children and Youth
The ACA requires that private plans cover without cost-sharing preventive services for children and adolescents including some of the immunization and screening services described in the previous two categories, behavioral and developmental assessments, iron and fluoride supplements, and screening for autism, vision impairment, lipid disorders, tuberculosis, and certain genetic diseases.

Preventive Services for Women
In addition to the previous mentioned services, the ACA authorized additional coverage requirements for women without cost-sharing, including well-woman visits, all FDA-approved contraceptives and related services, broader screening and counseling for STIs and HIV, breastfeeding support and supplies, and domestic violence screening.

Review your summary plan description to see what preventive services your health plan covers.

For more details about the preventive services covered by health plans under the Affordable Care Act (ACA) go to this link: