Prior to the Affordable Care Act, many people went without preventive health coverage. Now that no longer has to be the case. Every health insurance plan must cover a handful of essential health benefits including preventive care. That means, if you sign up for a health insurance plan through the Marketplace, you can take advantage of an extensive list of preventive care services. Plus, as HealthCare.gov points out, these preventive health services are completely free as long as they are provided by a doctor or provider within your health insurance network.
Before we jump in, download our FREE preventive care guide highlighting the services available to you. This can come in handy when you’re scheduling future doctors appointments, vaccinations, or screenings.
What exactly is preventive care?
Preventive care is healthcare that helps a person stay healthy, or screens for illnesses early on. This includes checkups with healthcare providers, services such as immunizations, specialized care for women and children, plus more.
According to the Centers For Disease Control (CDC), “the right preventive care at every stage of life helps all Americans stay healthy, avoid or delay the onset of disease, keep diseases they already have from becoming worse or debilitating, lead productive lives, and reduce costs.” Preventable chronic diseases include cancer, heart disease, and diabetes, so there are many health benefits to receiving preventive care.
What preventive services are covered in my Marketplace plan?
There are three groups of people who can receive preventive care for free with a Marketplace health insurance plan. These include women, children (under 18), and all adults. The preventive services offered to each of these groups differ slightly, depending on ages and needs. However, every adult over 18 who purchases a plan through the Health Insurance Marketplace has access to the following:
- Abdominal aortic aneurysm (one-time screening for male smokers)
- Alcohol misuse screening and behavioral counseling
- Aspirin use to help prevent heart attack or stroke
- Blood pressure screening
- Cholesterol screening (for anyone considered high risk)
- Colorectal cancer screening (for adults 50+)
- Depression screening
- Diabetes (Type 2) screening (for adults with high blood pressure)
- Diet counseling (for adults considered to be high risk for chronic disease)
- Hepatitis B screening
- Hepatitis C screening
- HIV screening
- Immunization vaccines (coverage may depend on the specific vaccine)
- Diphtheria
- Hepatitis A
- Hepatitis B
- Herpes Zoster
- Human Papillomavirus (HPV)
- Influenza (flu)
- Measles
- Meningococcal
- Mumps
- Pertussis
- Pneumococcal
- Rubella
- Tetanus
- Varicella (chickenpox)
- Lung cancer screening (for adults considered high risk)
- Obesity screening and counseling
- Sexually transmitted infection (STI) prevention counseling
- Syphilis screening
- Tobacco Use screening
Preventive Care Services for Women
Women who are covered under a Marketplace health plan are offered a wide range of preventive services, without having to pay a copay or coinsurance.
These services generally include:
- Breast cancer genetic test counseling – BRCA (for women considered high risk)
- Breast cancer mammography screenings (every 1-2 years for women 40+)
- Cervical cancer screening
- Breast cancer chemoprevention counseling (for women considered high risk)
- Chlamydia infection screening
- Domestic and interpersonal violence screening and counseling
- Gonorrhea screening
- HIV screening and counseling
- Human Papillomavirus (HPV) screening (for women 30+ with normal cytology results)
- Osteoporosis screening (for women 60+)
- Rh incompatibility screening and follow-up testing (for women considered high risk)
- Sexually transmitted infection (STI) counseling
- Syphilis screening
- Tobacco use screening and interventions
- Well-woman visits to get recommended services (for women under 65)
There are additional free preventive services for women who are pregnant or who are trying to become pregnant:
- Routine anemia screening
- Comprehensive breastfeeding support and counseling
- Access to breastfeeding supplies for both pregnant and nursing women
- Barrier birth control methods (e.g. diaphragms and sponges)
- Hormonal birth control methods (e.g. birth control pills and vaginal rings)
- Implanted birth control methods (e.g. intrauterine devices)
- Emergency contraception (e.g. Plan B® and ella®)
- Sterilization procedures
- Patient education and counseling
- Folic acid supplements
- Gestational diabetes screening (for women 24-28 weeks pregnant, and those at high risk of developing gestational diabetes)
- Gonorrhea screening
- Hepatitis B screening (for pregnant women at their first prenatal visit)
- Rh Incompatibility screening (for all pregnant women, and follow-up testing for women at higher risk)
- Syphilis screening
- Expanded tobacco intervention and counseling (for women who are pregnant and use tobacco)
- Urinary tract or other infection screening
Preventive Care Services for Children Under 18
Children under 18 who are covered under an ACA Marketplace plan have access to many robust preventive care services, such as:
- Alcohol and drug use assessments (for adolescents)
- Autism screening (for children between 18-24 months)
- Behavioral assessments
- Blood pressure screening
- Cervical dysplasia screening (for sexually active females)
- Depression screening (for adolescents)
- Developmental screening (for children under 3)
- Dyslipidemia screening (for children considered high risk for lipid disorders)
- Fluoride chemoprevention supplements (for children who do not have access to a water source that contains fluoride)
- Gonorrhea preventive medication (for all newborns)
- Hearing screening (for all newborns)
- Height, weight, and body mass index (BMI) measurements
- Hematocrit or hemoglobin screening
- Hemoglobinopathies or sickle cell screening (for newborns)
- Hepatitis B screening (for adolescents considered high risk)
- HIV screening (for adolescents considered high risk)
- Hypothyroidism screening (for newborns)
- Immunization vaccines (coverage may depend on the specific vaccine)
- Diphtheria, Tetanus, Pertussis (whooping cough)
- Haemophilus influenza (flu) type b
- Hepatitis A
- Hepatitis B
- Human Papillomavirus (HPV)
- Inactivated Poliovirus
- Influenza (flu)
- Measles
- Meningococcal
- Pneumococcal
- Rotavirus
- Varicella (chickenpox)
- Iron supplements (for children at risk for anemia between 6-12 months)
- Lead screening (for children at risk of exposure)
- Medical history
- Obesity screening and counseling
- Oral health risk assessment (for children up to 10)
- Phenylketonuria (PKU) screening (for newborns)
- Sexually transmitted infection (STI) prevention counseling and screening (for adolescents considered high risk)
- Tuberculin testing (for children considered high risk)
- Vision screening
When can I enroll in a Marketplace plan?
You can enroll in a Marketplace plan during the annual Open Enrollment Period, which begins November 1st and ends on January 15 in most states. However, if you experience a Qualifying Life Event outside of the annual Open Enrollment Period, you may be able to enroll during a Special Enrollment.
If you enroll in coverage through HealthSherpa, you will have access to a FREE HealthSherpa account. You can even sign up if you enrolled elsewhere! In your account, you can access information about your coverage, find out how much your prescriptions cost, search for and choose a new doctor, report life changes to the Marketplace, download tax forms, and more. Click here to sign up.
What preventive care is covered by Medicare?
Older adults on medicaid health plans can and should also receive preventive care, especially preventive counseling. Medicare health plans cover a wide variety of preventive services, from exams and lab tests, to certain shots, and even educational services. To learn more about which preventive healthcare is offered by Medicare, visit Medicare.gov.
What preventive care is covered by Medicaid?
According to Medicaid.gov, “preventive health care services include immunizations, screenings for common chronic and infectious diseases and cancers, clinical and behavioral interventions to manage chronic disease and reduce associated risks, and counseling to support healthy living and self-management of chronic disease.”
Visit Medicaid.gov to learn more about which preventive care services are available.
Before you go…
Don’t forget to download our FREE preventive care guide highlighting the different types of preventive care services available to you!