Many health plans are required to cover certain preventive care services to adults at no cost under the Affordable Care Act, such as mammograms and colonoscopies. All health plans sold through the health insurance marketplaces — where small businesses and consumers can shop for coverage come Oct. 1 — and many other plans must cover the following list of preventive services without charging you a co-payment or co-insurance:
- 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 (colonoscopies) 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 for adults — doses, recommended ages and recommended populations vary:
- Hepatitis A
- Hepatitis B
- Herpes zoster
- Human papillomavirus (HPV)
- Influenza (flu shot)
- Measles, mumps, rubella
- Meningococcal
- Pneumococcal
- Tetanus, diphtheria, pertussis
- Varicella
- Obesity screening and counseling for all adults
- Sexually transmitted infection 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
Preventive health services for women
Most health plans must cover additional preventive health services for women. All marketplace health plans and many other plans must cover the following list of preventive services for women without charging a co-payment or co-insurance:
- 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 one to two 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; must be prescribed by a health-care provider for women of reproductive age, not including drugs that induce abortion. This does not apply to health plans sponsored by certain exempt “religious employers.” Plans are not required to cover all brands of birth control.
- 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 threeyears for women with normal urine test 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
Source: HealthCare.gov
The required preventive benefits include services found to be effective by the U.S. Preventive Services Task Force; immunizations endorsed by the U.S. Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices; pediatric services recommended by U.S. Health Resources and Services Administration’s Bright Futures for Children program.
You have lots of questions about the Affordable Care Act, aka Obamacare. The Sun Journal and the Bangor Daily News want to help you understand what the ACA will mean for you and your family.
- Free breast pumps! And other little-known features buried in the ACA
- Free preventive care? It’s one of the benefits (and controversies) of the ACA
- The list: Free preventative care
- Affordable Care Act 101: We break down the ACA, what it does and what it requires you to do.
- Just the FAQs ma’am: Frequently asked questions and helpful answers
- An ACA Timeline: How health care coverage has evolved.
- Where to get assistance and more info: There are more sources of information and help understanding how the Affordable Care Act affects you.
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