Navigating the System

Empower yourself as a patient, and learn how to get the most out of your benefits. Each plan is different, so this section of our guide will help you understand what it is that you should look for when you receive your insurance information.  This section will help you navigate the health care system when you need care.

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Topic Area: Getting care, what's covered

Does health insurance cover preventive services?

Yes. In fact, most health plans must cover a certain set of preventive services at no cost to you, when delivered by an in-network provider.

Screenings and Counseling

  • Screening for diabetes, cholesterol, obesity, various cancers, including prostate, HIV, and sexually transmitted infections (STIs)
  • Counseling for drug and tobacco use, healthy eating, and other common health concerns

 

Routine Immunizations

Recommended routine immunizations for adults and children such as influenza, meningitis, tetanus, HPV, hepatitis A and B, measles, mumps, rubella, and varicella

 

Children and Adolescents

In addition to some of the immunization and screening services described above:

  • Behavioral and developmental assessments
  • Iron and fluoride supplements
  • Screening for autism, vision impairment, lipid disorders, tuberculosis, and certain genetic diseases

 

Women

In addition to the services described above:

  • Well-woman visits
  • FDA-approved contraceptives and related services
  • Services for women who are pregnant or may become pregnant
  • Breastfeeding support and supplies
  • Domestic violence screening

 

Behavioral Health Services

  • Screening for depression

 

 

These are just some examples and the list is updated on a regular basis. Check the list of preventive services covered by health plans under the Affordable Care Act (ACA) go to this link: https://www.healthcare.gov/coverage/preventive-care-benefits/

Be sure to review your summary of benefits and coverage document to see what preventive services your health plan covers – there are some exceptions. And, learn more for tips to help you avoid unexpected costs.

6/10/2024

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