What is Covered by Preventive Healthcare Insurance?

Preventive Healthcare became mandatory ever since the Affordable Care Act was passed. All insurance plans are required to cover various preventive doctor visits and examinations at no cost to the consumer.

Any annual physical exam is covered by insurance plans, and insurance companies are obliged to provide such services to the consumer.

However, some insurance companies provide free preventive care only in their authorized healthcare organizations or clinics.

What are preventive healthcare services?

Preventive healthcare services are categorized into three 

  • For adults
  • For women
  • For children

However, the ACA-compliant plans are supposed to cover these services.

Preventive care for adults

Adults over 18 years old are subjected to this preventive care service. They are subjected to various screening tests and preventive care to avoid future diseases and treatments.

Let’s take a look at various preventive care for adults:

  • Alcohol misuse exam
  • Blood pressure check
  • Abdominal aortic aneurysm for men who have smoked
  • Cholesterol level check for adults of specific age or at risk of cholesterol
  • Colorectal cancer screening for adults above 50 years
  • Depression screening
  • Type 2 diabetes check for high blood pressure adults 
  • Hepatitis B check for people at risk
  • Hepatitis C for adults born between the year 1945 -1965
  • Lung cancer check for adults between 55-80 years who smoke heavily or quit smoking
  • Obesity check
  • Syphilis check for adults at risk

Preventive care for women

Preventive care for women is categorized into two – preventive care for all women and  preventive care for women who are expecting or may become pregnant.

Preventive care for all women

  • Breast cancer test
  • Breast cancer mammography test every year or every 2 years
  • Breast cancer counseling
  • Cervical cancer test
  • Chlamydia infection test
  • Domestic violence check
  • Gonorrhea check
  • HIV test and counseling
  • Tobacco use check
  • STI counseling

Preventive care for pregnant women or those who may become pregnant

  • Anemia check
  • Breastfeeding support and counseling
  • Breastfeeding supplies
  • FDA approved contraceptives, procedures, and counseling
  • Gestational diabetes check for women 24-28 weeks pregnant
  • Tobacco intervention and counseling
  • Urinary tract or any other infection check

Preventive care for children

Any child under the age of 18 is subjected to the following preventive care:

  • Autism test at ages 18 and 24 months
  • Blood pressure check
  • Depression check for adolescents
  • Alcohol and drug abuse for adolescents
  • Behavioral check
  • Dyslipidemia check for children between 1-17 years old
  • Height, weight and BMI check
  • HIV tests for adolescents
  • Hepatitis B test for adolescents at risk
  • Lead exposure check for children at risk
  • Oral health checkup for children who are 0-10 years old
  • Vision test
  • Obesity test

Wellness programs

Other than preventive services, insurance companies also provide wellness programs. But most consumers are either unaware or just do not make use of this benefit. Before you avail any wellness program, check with your insurance company whether it is covered and keep a list of all services that are covered in your plan.

Preventive services will be offered free of charge as long as the insurance company covers it and it is within its network of healthcare organizations & clinics. The ACA compliant plans will surely cover such services and it is advisable to opt for such medical insurance plans.

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