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Need Health Insurance?
What Preventive Services are Covered by Obamacare?
Chronic disease and conditions such as heart disease, stroke, cancer, diabetes, obesity and arthritis are among the
most common, costly and preventable of all health problems in America.1 They are the leading cause of death and
disability in our nation—of the top causes of death in 2010, seven were chronic diseases; heart disease and cancer
together accounted for nearly 48 percent of all deaths2—and 75 percent of health care dollars go to treating them.3
Many of these conditions are preventable and even treatable (and often less expensive to treat) when detected
early. As such, preventive care is an essential part of maintaining a healthy lifestyle. Preventive care focuses on
disease prevention, as opposed to reactionary treatment. It includes our day-to-day behaviors (i.e., eating a healthy
diet, getting enough exercise, managing stress) as well as our medical care (i.e., visiting the doctor for health
screenings, discussing health concerns, getting immunizations).
Obamacare and Preventive Medicine
Many argue that preventive medicine saves lives and money. A study led by the National Commission on
Prevention Priorities found that preventive services such as daily aspirin use, tobacco cessation support and alcohol
abuse screening can potentially save 2 million lives and nearly $4 billion annually.4 Furthermore, the research
concluded that if 90 percent of the population had access to the three aforementioned preventive services and
colorectal cancer screening, "the four interventions alone would result in more than 100,000 years of life saved."
The Affordable Care Act signed into law on March 23, 2010, was intended to help make prevention more affordable
and accessible to all Americans.5 It includes 59 preventive services (i.e., screenings, counseling, and
immunizations) for men, women and children.

Adults and Preventive Care
There are 15 covered preventive services for adults with ACA-compliant health insurance plans. These services
include the following6:
1. Abdominal aortic aneurysm one-time screening for men of specified ages who have ever smoked
2. Alcohol misuse screening and counseling
3. Aspirin use to prevent cardiovascular disease for men and women of certain ages
4. Blood pressure screening for all adults
5. Cholesterol screening for adults of certain ages or at higher risk
6. Colorectal cancer screening for adults over 50
7. Depression screening for adults
8. Diabetes (Type 2) screening for adults with high blood pressure
9. Diet counseling for adults at higher risk for chronic disease
10. HIV screening for everyone ages 15 to 65, and other ages at increased risk
11. Immunization vaccines for adults—doses, recommended ages, and recommended populations vary:
o Hepatitis A
o Hepatitis B
o Herpes Zoster
o Human Papillomavirus
o Influenza (Flu Shot)
o Measles, Mumps, Rubella
o Meningococcal
o Pneumococcal
o Tetanus, Diphtheria, Pertussis
o Varicella
12. Obesity screening and counseling for all adults
13. Sexually transmitted infection (STI) prevention counseling for adults at higher risk
14. Syphilis screening for all adults at higher risk
15. Tobacco Use screening for all adults and cessation interventions for tobacco users

Women and Preventive Care
The 22 covered preventive services for women, including pregnant women, took effect with plan years starting on or
after Aug. 1, 2012.7 They include the following8:
1. Anemia screening on a routine basis for pregnant women
2. Breast Cancer Genetic Test Counseling (BRCA) for women at higher risk for breast cancer
3. Breast Cancer Mammography screenings every 1 to 2 years for women over 40
4. Breast Cancer Chemoprevention counseling for women at higher risk
5. Breastfeeding comprehensive support and counseling from trained providers, and access to breastfeeding
supplies, for pregnant and nursing women
6. Cervical Cancer screening for sexually active women
7. Chlamydia Infection screening for younger women and other women at higher risk
8. 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."
9. Domestic and interpersonal violence screening and counseling for all women
10. Folic Acid supplements for women who may become pregnant
11. Gestational diabetes screening for women 24 to 28 weeks pregnant and those at high risk of developing
gestational diabetes
12. Gonorrhea screening for all women at higher risk
13. Hepatitis B screening for pregnant women at their first prenatal visit
14. HIV screening and counseling for sexually active women
15. Human Papillomavirus (HPV) DNA Test every 3 years for women with normal cytology results who are 30 or
older
16. Osteoporosis screening for women over age 60 depending on risk factors
17. Rh Incompatibility screening for all pregnant women and follow-up testing for women at higher risk
18. Sexually Transmitted Infections counseling for sexually active women
19. Syphilis screening for all pregnant women or other women at increased risk
20. Tobacco Use screening and interventions for all women, and expanded counseling for pregnant tobacco users
21. Urinary tract or other infection screening for pregnant women
22. Well-woman visits to get recommended services for women under 65

Children and Preventive Care
There are 15 covered preventive services for children with ACA-compliant health insurance plans. They include the
following9:
1. Alcohol and drug use assessments for adolescents
2. Autism screening for children at 18 and 24 months
3. Behavioral assessments for children at the following ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14
years, 15 to 17 years
4. Blood Pressure screening for children at the following ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14
years, 15 to 17 years
5. Cervical dysplasia screening for sexually active females
6. Depression screening for adolescents
7. Developmental screening for children under age 3
8. Dyslipidemia screening for children at higher risk of lipid disorders at the following ages: 1 to 4 years, 5 to 10
years, 11 to 14 years, 15 to 17 years
9. Fluoride Chemoprevention supplements for children without fluoride in their water source
10. Gonorrhea preventive medication for the eyes of all newborns
11. Hearing screening for all newborns
12. Height, weight and Body Mass Index measurements for children at the following ages: 0 to 11 months, 1 to 4
years, 5 to 10 years, 11 to 14 years, 15 to 17 years
13. Hematocrit or Hemoglobin screening for children
14. Hemoglobinopathies or sickle cell screening for newborns
15. HIV screening for adolescents at higher risk
16. Hypothyroidism screening for newborns
17. Immunization vaccines for children from birth to age 18—doses, recommended ages, and recommended
populations vary:
o Diphtheria, tetanus, pertussis
o Haemophilus influenzae type B
o Hepatitis A
o Hepatitis B

o Human papillomavirus
o Inactivated poliovirus
o Influenza (flu shot)
o Measles, mumps, rubella
o Meningococcal
o Pneumococcal
o Rotavirus
o Varicella
18. Iron supplements for children ages 6 to 12 months at risk for anemia
19. Lead screening for children at risk of exposure
20. Medical History for all children throughout development at the following ages: 0 to 11 months, 1 to 4 years, 5 to
10 years, 11 to 14 years, 15 to 17 years
21. Obesity screening and counseling
22. Oral health risk assessment for young children Ages: 0 to 11 months, 1 to 4 years, 5 to 10 years
23. Phenylketonuria (PKU) screening for this genetic disorder in newborns
24. Sexually transmitted infection (STI) prevention counseling and screening for adolescents at higher risk
25. Tuberculin testing for children at higher risk of tuberculosis at the following ages: 0 to 11 months, 1 to 4 years, 5
to 10 years, 11 to 14 years, 15 to 17 years
26. Vision screening for all children
Health insurance plans that began on or after Sept. 23, 2010, and qualify as minimum essential coverage
under Obamacare—both those sold on and away from the state-based and federally facilitated health
insurance exchanges—must include these preventive services at no additional cost to the insured.10 That
means you cannot be charged a copayment or coinsurance for these services, even if you have not yet met
your annual deductible. You must, however, visit a an in-network health care provider covered by health
insurance plan, so be sure to confirm as much beforehand. It is also important to note that health insurance
plans with grandfathered status (https://www.healthcare.gov/what-if-i-have-a-grandfathered-health-plan/)
may not include these preventive services at no extra cost to you; check with your health insurance plan to
confirm.




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