Which preventive care services are included in your Marketplace plan?

Did you know all health insurance plans bought on the Marketplace guarantee certain services, free of charge? As touched on in “Mental health care and the Marketplace”, every plan must cover a handful of essential health benefits. A few of these include outpatient care, emergency services, hospitalization, pre- and postpartum care, mental health care, prescription drugs, rehabilitative services, lab services, pediatric care, and preventive health services.

While it is very important to have an understanding of each of these benefits, we’re going to shine a spotlight on the category everyone needs and should be taking full advantage of – free preventive care.

What exactly is preventive care?

Preventive care services are intended to prevent disease rather than treat an existing case. Affordable Care Act (ACA) plans offer an incredible array of preventive services, from immunizations and screenings for everyone — to specialized care for women and children. For more information on specific services, you can always check out your plan benefits, HealthCare.gov, or the CDC.

What types of preventive care services are offered through the Marketplace?

Adults enrolled in a Marketplace plan can benefit from the following free preventive care services. And unless a specific recipient is noted (e.g. “one-time screening for male smokers”), any covered adult is eligible to receive them at no cost.
  • 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
There are also quite a few free, preventive care services offered to women:
  • Breast cancer genetic test counseling – BRCA (for women considered high risk)
  • Breast cancer mammography screenings (every 1-2 years for women 40+)
  • Breast cancer chemoprevention counseling (for women considered high risk)
  • Cervical cancer screening
  • 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)
Along with 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
And the following preventive care services are offered to children under the age of 18:
  • 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

We hope this article was informative and helped shed light on the many services you can access for free! While these services and their occasional corresponding treatments do not require a copay, there is a chance that individual factors like age and risk could influence cost. Your insurance provider can share more details when these unique instances occur.

Have any further questions about your plan? Reach out to the HealthSherpa team anytime!

HealthSherpa

HealthSherpa is a free website and team of real people who can help you find, enroll in, and make the best use of your marketplace health insurance.

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