Ever since the Affordable Care Act (ACA) came into play in 2010, it's been a game-changer for preventive health care. When you're shopping for an ACA-accredited Individual & Family plan through Alight, it's great to know the preventive services you and your family can get without dipping into your wallet.
Before the ACA, insurance companies had the choice whether to cover preventive services—and often at a cost. Now, it's not only mandatory for plans to cover these services, but they also have to do so without charging you copays, coinsurance, or deductibles. This means you can access numerous covered preventive services, cost-free, helping you and your family stay healthy.
What’s included in preventive care
The ACA covers a broad spectrum of preventive care, from vaccines to health screenings specifically tailored to adults, women, and children.
Preventive care for adults1
The ACA covers a broad spectrum of preventive care, from vaccines to health screenings specifically tailored to adults, women, and children.
- Vaccines: Get protected against a wide range of conditions: chickenpox, diphtheria, flu, hepatitis A and B, high cholesterol, HPV, measles, meningitis, mumps, whooping cough, rubella, shingles, and tetanus.
- Screening for diseases and conditions: ACA plans pay for tests to determine colorectal cancer, depression, hepatitis B and C, high blood pressure, high cholesterol, HIV, lung cancer, obesity, syphilis, tuberculosis, and type 2 diabetes.
- Screening for risks: You can also get screened to see if you’re at risk of developing certain specific conditions even if you haven’t been diagnosed, including alcohol misuse, falls, HIV, and tobacco use.
- Counseling: If you’re at risk of developing alcohol misuse, obesity, or a sexually transmitted infection (STI), an ACA plan pays for counseling to help you understand and reduce your risk.
Preventive care for children up to age 182
- Vaccines: If you have a child covered under an ACA plan, they’ll likely qualify for most or all the immunizations they’ll need at no extra cost, including chickenpox, diphtheria/tetanus/pertussis (DTaP), haemophilus influenza type b (Hib), HPV, flu, measles, meningitis, mumps, polio, rubella, and rotavirus.
- Screening for diseases and conditions: ACA plans usually cover checks to see if children have certain health problems. These checks can happen at different times as a child grows. They look for issues like autism, high blood pressure, depression, cholesterol problems, and other conditions such as hepatitis B, HIV, and thyroid problems.
- Screening for risks: Children generally can get screened for certain health risks, even if there’s no definitive diagnosis, including lead, obesity, oral health problems, and tuberculosis.
- Counseling: ACA plans also pay for counseling under certain conditions for covered children diagnosed with obesity or an STI.
- Assessments: Children covered under an ACA plan may qualify for a variety of assessments, some of which can occur at multiple ages, like alcohol, tobacco, and drug use; behavior; development; hearing; height, weight, body mass; and vision.
Other kinds of specialized preventive care: for children covered by an ACA plan may include:
- Fluoride supplements for kids who don't have fluoride in their drinking water
- Fluoride varnish for babies and kids to protect their teeth as soon as they start to come in
- Medication to protect newborns from eye infections caused by gonorrhea
- Treatments to prevent HIV in teenagers at high risk
- Regular health check-ups
Preventive care for adult women3
The preventive care requirements for women are organized a little differently, with a separate section just for those who are or could become pregnant.
- Screenings: Bone density, breast cancer mammography, cervical cancer (Pap smear), chlamydia, diabetes, domestic violence, gonorrhea, hepatitis B, HIV, tobacco use, and urinary incontinence.
- Other kinds of specialized preventive care for women include breast cancer genetic test and chemoprevention counseling, HIV prevention; STI and domestic violence counseling, and well-woman visits.
- Specialized preventive services for pregnant or potentially pregnant women includes checks for health concerns like gestational diabetes, hepatitis B, and maternal depression; screenings for pre-eclampsia, Rh incompatibility, syphilis, and urinary infections; breastfeeding guidance, birth control options along with education about them, supplements like folic acid, and help with quitting smoking.
Things to keep in mind
Requirements for plans available through the health insurance marketplace also include numerous exceptions and conditions:
- Preventive services must be delivered by a provider in your plan’s network.
- For children, the requirements for many preventive services vary by age group. Some screenings are meant to be repeated at various stages as the child grows.
- The preventive care requirements do not cover all patients at all ages and are subject to a variety of conditions, exclusions, and restrictions. Some cover only people within certain age groups; others restrict coverage to patients in certain high-risk groups.
- Always check with your insurance company or an Alight Retiree Health Solutions licensed Benefits Advisor if you have questions about preventive services.
Need help navigating your options?
If you’re switching from group coverage to an Individual & Family plan, Alight Retiree Health Solutions can help. Our licensed Benefits Advisors offer personalized, unbiased guidance so you can make informed decisions about your health care.
Sources
1Preventive Care Benefits for Adults
2 Preventive Care Benefits for Children
3 Preventive Care Benefits for Women
