Preventive Services Covered Under the Affordable Care Act
For patients with new health insurance plans or insurance policies that begin on or after September 23, 2010, the following preventive services must be covered without copayment or coinsurance or meeting a deductible, when these services are delivered by a network provider.
Covered Preventive Services for Adults
- Abdominal Aortic Aneurysm one-time screening for men of specified ages who have ever smoked
- Alcohol Misuse screening and counseling
- Aspirin use to 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 for adults over 50
- Depression screening for adults
- Type 2 Diabetes screening for adults with high blood pressure
- Diet counseling for adults at higher risk for chronic disease
- HIV screening for all adults at higher risk
- Immunization vaccines for adults — doses, recommended ages and recommended populations vary
- Hepatitis A
- Hepatitis B
- Herpes Zoster
- Human Papillomavirus
- Influenza (Flu Shot)
- Measles, Mumps, Rubella
- Meningococcal
- Pneumococcal
- Tetanus, Diphtheria, Pertussis
- Varicella
- Obesity screening and counseling for all adults
- Sexually Transmitted Infection (STI) prevention counseling for adults at higher risk
- Tobacco Use screening for all adults and cessation interventions for tobacco users
- Syphilis screening for all adults at higher risk
Covered Preventive Services for Women, Including Pregnant Women
The eight new prevention-related health services marked with an asterisk ( * ) must be covered with no cost-sharing in plan years starting on or after August 1, 2012.
- 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, as well as 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, as prescribed by a health care provider for women with reproductive capacity (not including abortifacient drugs). This does not apply to health plans sponsored by certain exempt "religious employers".*
- 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
- Human Immunodeficiency Virus (HIV) screening and counseling for sexually active women*
- Human Papillomavirus (HPV) DNA Test every three years for women with normal cytology 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 (STI) 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*
Covered Preventive Services for Children
- Alcohol and Drug Use assessments for adolescents
- Autism screening for children at 18 and 24 months
- Behavioral assessments for children at the following ages: zero to 11 months, one to four years, five to 10 years, 11 to 14 years, 15 to 17 years
- Blood Pressure screening for children at the following ages: zero to 11 months, one to four years, five to 10 years, 11 to 14 years, 15 to 17 years
- Cervical Dysplasia screening for sexually active females
- Congenital Hypothyroidism screening for newborns
- Depression screening for adolescents
- Developmental screening for children under age three
- Dyslipidemia screening for children at higher risk of lipid disorders at the following ages: one to four years, five to 10 years, 11 to 14 years, 15 to 17 years
- Fluoride Chemoprevention supplements for children without fluoride in their water source
- Gonorrhea preventive medication for the eyes of all newborns
- Hearing screening for all newborns
- Height, Weight and Body Mass Index measurements for children at the following ages: zero to 11 months, one to four years, five to 10 years, 11 to 14 years, 15 to 17 years
- Hematocrit or Hemoglobin screening for children
- Hemoglobinopathies or sickle cell screening for newborns
- HIV screening for adolescents at higher risk
- Immunization vaccines for children from birth to age 18 — doses, recommended ages, and recommended populations vary:
- Diphtheria, Tetanus, Pertussis
- Haemophilus influenzae type b
- Hepatitis A
- Hepatitis B
- Human Papillomavirus
- Inactivated Poliovirus
- Influenza (Flu Shot)
- Measles
- Meningococcal
- Pneumococcal
- Rotavirus
- Varicella
- Iron supplements for children ages six to 12 months at risk for anemia
- Lead screening for children at risk of exposure
- Medical History for all children throughout development at the following ages: zero to 11 months, one to four years, five to 10 years, 11 to 14 years, 15 to 17 years
- Obesity screening and counseling
- Oral Health risk assessment for young children ages: zero to 11 months, one to four years, five to 10 years
- Phenylketonuria (PKU) screening for this genetic disorder in newborns
- Sexually Transmitted Infection (STI) prevention counseling for adolescents at higher risk
- Tuberculin testing for children at higher risk of tuberculosis at the following ages: zero to 11 months, one to four years, five to 10 years, 11 to 14 years, 15 to 17 years
- Vision screening for all children
For more information on this and other Health Care Reform topics visit HealthCare.gov.