Health Insurance: Understanding What It Covers | Full List of Preventive Services

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Beginning in 2015, the Affordable Care Act (ACA) will require every health plan to cover all costs related to preventive services. Preventive services are tests and procedures to maintain health and prevent disease.

Insurance plans that do not currently cover costs for all preventive services have until December 31, 2014 to meet the ACA requirements. Coverage for preventive services will vary by state, so you should carefully review the services covered by your current plan, or a new one you select through a Health Insurance Marketplace.

 

 

Preventive Service

Men

Women

Children

Abdominal aortic aneurysm, one-time screening

Ages 65 to 75 years who have ever smoked

 

 

 

Advice about aspirin use to prevent cardiovascular disease

Ages 45 to 79 years

Ages 55 to 79 years

 

Alcohol misuse screening and counseling

 

 

 

Anemia screening

 

Pregnant

 

Autism screening

 

 

 

Ages 18 and 24 months

Behavioral assessments

 

 

 

Ages 0 to 11 months; 1 to 4 years; 5 to 10 years; 11 to 14 years; 15 to 17 years

Blood pressure screening

All ages

All ages

Ages 0 to 11 months; 1 to 4 years; 5 to 10 years; 11 to 14 years; 15 to 17 years

Breast cancer genetic testing and counseling (BRCA)

 

 

Those who have higher risk for breast cancer

 

Breast cancer mammography screening

 

Every 1 to 2 years after age 40 years

 

Breastfeeding - comprehensive support and counseling from trained providers; access to breastfeeding supplies

 

Pregnant and nursing

 

Cervical cancer screening

 

 

Sexually active

 

Cervical dysplasia screening

 

 

Sexually active

Chlamydia infection screening

 

 

Younger than age 25 and sexually active; older than age 25 with multiple sex partners

 

Cholesterol screening

Ages 35 years and older; younger than age 35 and have heart disease or risk factors for heart disease

Those who have heart disease or risk factors for heart disease

 

Colorectal cancer screening

Older than age 50

Older than age 50

 

Contraception - Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling, as prescribed by a health care provider (not including abortifacient drugs). This does not apply to health plans sponsored by certain exempt “religious employers.”

 

Those who have reproductive capacity

 

Depression screening

All ages

All ages

Adolescents

Developmental screening

 

 

Younger than age 3

Diabetes (Type 2) screening

Those who have high blood pressure

Those who have high blood pressure

 

Diet counseling

Those who have higher risk for chronic disease

Those who have higher risk for chronic disease

 

Domestic and interpersonal violence screening and counseling

 

 

All ages

 

Dyslipidemia screening

 

 

Those who have higher risk of lipid disorders at ages 1 to 4 years; 5 to 10 years; 11 to 14 years; 15 to 17 years

Fluoride chemoprevention supplements

 

 

Those without fluoride in their water source

Folic acid supplements

 

 

Those who may become pregnant

 

Gestational diabetes screening

 

 

For those 24 to 28 weeks’ pregnant and those at high risk of developing gestational diabetes

 

Gonorrhea screening

 

Those who have discharge from the penis or burning during urination

Those who have new or multiple sex partners; those not using a condom for each sexual encounter; those who use drugs; have ever had an STI

 

Gonorrhea preventive medicine (eyes)

 

 

All newborns

Hearing screening

 

 

All newborns

Height, weight, and body mass index measurements

 

 

Ages 0 to 11 months; 1 to 4 years; 5 to 10 years; 11 to 14 years; 15 to 17 years

Hematocrit or hemoglobin screening

 

 

All

Hemoglobinopathies or sickle cell screening

 

 

Newborns

Hepatitis B screening

 

 

Pregnant at their first prenatal visit

 

HIV screening

Ages 15 to 65 years, and other ages at increased risk

Sexually active, ages 15 to 65 years, and other ages at increased risk

Ages 15 to 18 years and other ages at increased risk

Human papillomavirus (HPV) DNA screening

 

 

Every 3 years for those with normal cytology results who are age 30 years or older

 

Hypothyroidism screening

 

 

Newborns

Immunization

  • Haemophilus influenzae type B
  • Hepatitis A
  • Hepatitis B
  • Herpes Zoster
  • Human papillomavirus
  • Inactivated poliovirus
  • Influenza (Flu shot)
  • Measles, mumps, rubella
  • Meningococcal
  • Pneumococcal
  • Rotavirus
  • Tetanus, diphtheria, pertussis
  • Varicella

 

Doses, recommended ages, and recommended populations vary

Doses, recommended ages, and recommended populations vary

Doses, recommended ages, and recommended populations vary

Iron supplements

 

 

6 to 12 months at risk for anemia

Lead screening

 

 

Those at risk of exposure

Medical history

 

 

Ages 0 to 11 months; 1 to 4 years; 5 to 10 years, 11 to 14 years ; 15 to 17 years

Obesity screening and counseling

All ages

All ages

All ages

Oral health risk assessment

 

 

Ages 0 to 11 months; 1 to 4 years; 5 to 10 years

Osteoporosis screening

 

 

Older than age 60 depending on risk factors

 

Phenylketonuria (PKU) screening

 

 

Newborns

Rh incompatibility screening

 

 

Pregnant women and follow-up testing for women at higher risk

 

Sexually transmitted infection (STI) prevention counseling

For those at higher risk

For those sexually active and/or at higher risk

Adolescents at higher risk

Syphilis screening

 

Those at higher risk

Pregnant or at increased risk

 

Tobacco use screening and interventions

 

All ages

All ages and expanded counseling for pregnant tobacco users

 

Tuberculin testing

 

 

At higher risk of tuberculosis at ages 0 to 11 months; 1 to 4 years; 5 to 10 years; 11 to 14 years, 15 to 17 years

Urinary tract or other infection screening

 

 

Pregnant

 

Vision screening

 

 

All ages

Well-woman visits

 

Younger than age 65

 

Written by familydoctor.org editorial staff

Reviewed/Updated: 12/13
Created: 09/00

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