Medical Insurance Blog

Your Guide to Preventative Care under Healthcare Reform

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The Patient Protection and Affordable Care Act requires that all new health plans issued on September 23, 2010 or later must offer medical insurance coverage for preventative care without any cost sharing, copays or deductibles when performed in-network.

The services that are covered are those that have been recommended by the U.S. Preventative Services Task Force, the Centers for Disease Control and Prevention, and the Health Resources and Services Administration.

Here is a list of the preventative services that are covered for adults:

• A preventative medical exam that is age-appropriate
• Discussions with primary care physicians regarding alcohol misuse
• Discussions with primary care physicians regarding obesity and weight management.
• One time screening for men aged 65-75 who have smoked in their past, for abdominal aortic aneurysm.
• Blood pressure screenings
• Cholesterol screenings for those adults that have a higher risk of cardiovascular disease
• Screenings for colorectal cancer for adults between 50 and 75 years of age
• Screenings for prostate cancer for men between 50 and 75 years of age
• Screenings for depression
• Screening for type 2 diabetes for adults that have high blood pressure
• Discussions with primary care physicians regarding the usage of aspirin for those adults that have a higher risk of cardiovascular disease.
• Discussions with primary care physicians regarding diet counseling for adults who also have a high risk for chronic diseases.
• Immunizations for adults (however, recommended ages, populations, and doses vary)
  • Dipteria
  • Hepatitis A & B
  • Herpes zoster
  • Human papillomavirus
  • Influenza
  • Measles, mumps and rubella
  • Meningococcal
  • Pertussis
  • Pneumococcal
  • Tatanus
  • Varicella

Counseling, screening and prevention of sexually transmitted infections such as:

• Chlamydia
• Gonorrhea
• HIV
• Syphilis
• Tobacco Cessation discussion with a primary care physician.

In addition, here is a list of covered preventative services for women and pregnant women:

• Preventative medical exam, which is age-appropriate
• Chemo prevention discussion with a primary care physician for women that have a higher risk of breast cancer.
• Discussion with a primary care physician about ovarian and/or breast cancer susceptibility due to family history.
• Mammogram screening for breast cancer for women between the ages of 50 and 74.
• Mammogram screening for breast cancer in other age groups, as determined jointly by physician and patient.
• Cervical cancer screening for women between the ages of 21 and 65.
• Osteoporosis screening for women 65 years old or older, and for women who are at a higher risk.
• Tobacco cessation discussion with a primary care physician.
• Screening for chlamydia infection for sexually active men and women who are at higher risk.
• Screening for gonorrhea for all women who are at higher risk.
• Scheduled prenatal office visits and first postpartum visit.
• Screening for syphilis in all pregnant women, and those women that are at a higher risk.
• Screening for anemia for pregnant women
• Screening for urinary tract infections or other infections for pregnant women.
• Screening for Hepatitis B for pregnant women at their first prenatal visit.
• Breast feeding discussion with a primary care physician about interventions to support and promote breast-feeding.
• Folic acid supplements discussion with a primary care physician for women who may plan on becoming pregnant.
• Screening for prescription incompatibility for pregnant women, and follow up testing for those women that may be at a higher risk.

Here is a list of children's covered preventative services:

• Preventative medical exam that's appropriate for the child's age
• Medical history records for all children through the years of their development
• Body mass index, height & weight measurements
• Behavioral assessments by a primary care physician for children of all ages.
• Developmental screening and surveillance by a primary care physician for all children less than 3 years old.
• For adolescents, a discussion with a primary care physician about drug and alcohol use assessments.
• Screening for autism for children at 18 months of age, and 24 months of age, performed by a primary care physician.
• Screening for cervical dysplasia for females that are sexually active.
• Screening for congenital hypothyroidism for newborns.
• Screening for phenylketonuria (PKU) for newborns.
• Screening for dyslipidemia for children that may be at a higher risk of lipid disorders. 
• For young children, a risk assessment for oral health performed by a primary care physician.
• A screening for lead amongst children that may be at risk of exposure.
• A discussion with a primary care physician about screening for obesity and obesity counseling.
• Medication to prevent gonorrhea for all newborns' eyes.
• Screening for hearing for newborns.
• Screening for vision for all children.
• Screening for hemoglobin or hematocrit
• Screening for sickle cell or hemoglobinopathies for newborns.
• Testing for tuberculin amongst children who have a higher risk of tuberculosis.
• Screening for HIV amongst adolescents that may be at higher risk.
• Counseling for the prevention of sexually transmitted infections amongst adolescents that may be at higher risk.
• A discussion with a primary care physician about fluoride supplements for those children that don't have any fluoride in their water.
• A discussion with a primary care physician about iron supplements for 6-12 month old babies that may be at risk for anemia.
• Immunizations from birth to 18 years old (recommended populations, recommended ages and doses vary):
  • Diphtheria
  • Haemophilus influenza type B
  • Hepatitis A
  • Hepatitis B
  • Human papillomavirus
  • Inactivated poliovirus
  • Influenza
  • Measles
  • Meningococcal
  • Mumps
  • Pertussis
  • Pneumococcal
  • Rotavirus
  • Rubella
  • Tetanus