As a woman, figuring out your healthcare options and understanding the services available to you is a vital part of your preventive care. Thankfully, an important provision of the Affordable Care Act (ACA) requires that Marketplace plans cover certain preventive services for American women. This includes check-ups and routine screenings, as well as specialty services for pregnant women. As of 2012, these types of preventive services must be free, even for non-grandfathered health plans. This means if you go to the doctor for anything related to your reproductive healthcare, you should not have to pay a copay or receive a bill later on. However, there are some stipulations, especially related to an employer’s religious objections, so it’s important for you to check with your network provider before receiving any preventive health services.
To make things easy, we created a FREE guide that highlights each preventive care service offered. Grab it here and save to your computer for later. Now let’s look at which women’s health and preventive services are covered by the ACA mandate.
What is preventive care?
Preventive care is the healthcare that helps a person manage and maintain their health before a condition or illness becomes serious. For everyone, preventive care includes routine tests and screenings, vaccines, and annual checkups with your doctor. For women, preventive care can also include mammography screenings to check for breast cancer, cervical cancer screenings, testing for sexually transmitted infections, and information about contraceptive methods. And for pregnant women, preventive care also includes most routine prenatal visits and screenings, including gestational diabetes screenings. If you or a family needs these services, the ACA’s provision makes it easy and affordable for you to receive them.
Which women’s health services are considered preventive care?
Below are a few women’s preventive services that the majority of women will access and benefit from within their lifetime. Marketplace plans guarantees these services, with no copay or cost sharing. This set of preventive services may differ depending on your health plan. Therefore, it’s a good idea to check with your health insurance provider to see which preventive services are covered for you.
Well-woman visit
The Department of Health and Human Services recommends that women over 18 have an annual preventive check-up in order to receive an overall wellness assessment and any recommendations for future care. A well-woman visit will typically consist of a routine physical and, depending on sexual activity and age, could also include screening for sexually transmitted infections and patient education, a pelvic exam/pap smear, a mammography screening, and screenings for reproductive capacity for women who want to become pregnant. Well-woman can happen at your primary care physicians office, or at a women’s health clinic, depending on your insurance.
Contraception
Contraception with an approval by the Food and Drug Administration (FDA) is generally free for women. This includes contraceptive methods such as birth control pills and implant devices. Note: There are some exceptions for employers who cite religious objections. Read the full list of covered contraceptive methods here.
Sexually transmitted infection screening and counseling
Sexually active women can receive annual screening and counseling on sexually transmitted infections. This includes but is not limited to the human papillomavirus (HPV), chlamydia, and gonorrhea. This can also included HIV screenings and syphilis screenings.
Domestic violence screening and counseling
All adolescent and adult women can receive domestic violence screenings and counseling. The CDC notes that 1 in 3 women will experience intimate partner violence in their lifetime. Annual screenings to identify the signs of domestic violence and abuse can help prevent it in the future.
Unless otherwise noted by your health insurance plan, all women can receive some additional preventive services with the following benefits at no cost.
- Breast cancer prevention, including genetic testing for women who may be at high risk, like women with the BRCA gene. This also includes mammograms every 1-2 years for women over 40, and chemo-prevention counseling for women who are high risk.
- Osteoporosis screening for all women over 60. One in two women will experience complications (often a broken bone) from osteoporosis in their lifetime, making this an invaluable free service.
- Diabetes screening for women who have been diagnosed with gestational diabetes who have never had type 2 diabetes and aren’t currently pregnant.
- Tobacco use screening and interventions, as smoking can increase the risk of certain illnesses for women.
- Colorectal cancer screenings.
- Blood pressure screenings.
Like we discussed above, sexually transmitted infection prevention, screenings, and counseling are available for sexually active women, as well as the following:
- Birth control methods including diaphragms, sponges, birth control pills, vaginal rings, IUDs, and other implants.
- Cervical cancer screenings every three years in combination with a pap smear for women between 21-65.
- Screening for sexually transmitted infections, including chlamydia, gonorrhea, HPV, syphilis, and more.
- HIV screening and counseling.
Women who are pregnant or are trying to become pregnant require specific care. Therefore, these women receive additional preventive services through their Marketplace plan.
- Marketplace plans and private health insurance plans must cover maternity and childbirth. Medicaid and Child Health Insurance Program (CHIP) also cover maternity and childbirth. Although coverage varies from state to state, so it’s important to check your state’s guidelines and benefits regularly.
- Anemia screening throughout pregnancy.
- Other screenings will occur at different stages of pregnancy. Women will receive tests for Hepatitis B and have an Rh incompatibility screening at the first prenatal visit. They will also test for gestational diabetes between 24-28 weeks.
- Breastfeeding education, counseling, and supplies.
- Sterilization procedures.
- Folic acid supplements.
- Testing for infections of the urinary tract (UTIs).
- Follow-up visits with their healthcare provider.
Medicaid plans cover pregnancy and childbirth. And if you were pregnant before you enrolled in your current health plan, you cannot be charged more or penalized.
It’s important to raise awareness around all of the free preventive services available to women with Marketplace plans. After all, there are common misconceptions that free preventive healthcare for women begins and ends with the “well-woman visit.” In reality there are actually many more health resources available throughout a woman’s life. As always, you should speak with your health plan provider for more information regarding specific preventive coverage. Factors such as age and risk factor may affect co-payment, cost-sharing, or coinsurance for certain services.
Originally published on Feb 13, 2018.