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

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

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 ServiceMenWomenChildren
Abdominal aortic aneurysm, one-time screeningAges 65 to 75 years who have ever smoked

 

Advice about aspirin use to prevent cardiovascular diseaseAges 45 to 79 yearsAges 55 to 79 years
Alcohol misuse screening and counseling
Anemia screeningPregnant
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 screeningAll agesAll agesAges 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 screeningEvery 1 to 2 years after age 40 years
Breastfeeding – comprehensive support and counseling from trained providers; access to breastfeeding suppliesPregnant and nursing
Cervical cancer screening

 

Sexually active
Cervical dysplasia screeningSexually active
Chlamydia infection screening

 

Younger than age 25 and sexually active; older than age 25 with multiple sex partners
Cholesterol screeningAges 35 years and older; younger than age 35 and have heart disease or risk factors for heart diseaseThose who have heart disease or risk factors for heart disease
Colorectal cancer screeningOlder than age 50Older 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 screeningAll agesAll agesAdolescents
Developmental screeningYounger than age 3
Diabetes (Type 2) screeningThose who have high blood pressureThose who have high blood pressure
Diet counselingThose who have higher risk for chronic diseaseThose who have higher risk for chronic disease
Domestic and interpersonal violence screening and counseling

 

All ages
Dyslipidemia screeningThose 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 supplementsThose 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 urinationThose 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 screeningAll newborns
Height, weight, and body mass index measurementsAges 0 to 11 months; 1 to 4 years; 5 to 10 years; 11 to 14 years; 15 to 17 years
Hematocrit or hemoglobin screeningAll
Hemoglobinopathies or sickle cell screeningNewborns
Hepatitis B screening

 

Pregnant at their first prenatal visit
HIV screeningAges 15 to 65 years, and other ages at increased riskSexually active, ages 15 to 65 years, and other ages at increased riskAges 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 screeningNewborns
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 varyDoses, recommended ages, and recommended populations varyDoses, recommended ages, and recommended populations vary
Iron supplements6 to 12 months at risk for anemia
Lead screeningThose at risk of exposure
Medical historyAges 0 to 11 months; 1 to 4 years; 5 to 10 years, 11 to 14 years ; 15 to 17 years
Obesity screening and counselingAll agesAll agesAll ages
Oral health risk assessmentAges 0 to 11 months; 1 to 4 years; 5 to 10 years
Osteoporosis screening

 

Older than age 60 depending on risk factors
Phenylketonuria (PKU) screeningNewborns
Rh incompatibility screening

 

Pregnant women and follow-up testing for women at higher risk
Sexually transmitted infection (STI) prevention counselingFor those at higher riskFor those sexually active and/or at higher riskAdolescents at higher risk
Syphilis screening

 

Those at higher riskPregnant or at increased risk
Tobacco use screening and interventions

 

All agesAll ages and expanded counseling for pregnant tobacco users
Tuberculin testingAt 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 screeningAll ages
Well-woman visitsYounger than age 65