Preventive Care

Under the Affordable Care Act, you and your family may be eligible for some important preventive services — which can help you avoid illness and improve your health — at no additional cost to you.

• Read the full list of covered preventive services.
• Read a list of covered preventive services for women, issued August 1, 2011.

What This Means for You

If your plan is subject to these new requirements, you may not have to pay a copayment, co-insurance, or deductible to receive recommended preventive health services, such as screenings, vaccinations, and counseling.

For example, depending on your age, you may have access — at no cost — to preventive services such as:

• Blood pressure, diabetes, and cholesterol tests
• Many cancer screenings, including mammograms and colonoscopies
• Counseling on such topics as quitting smoking, losing weight, eating healthfully, treating depression, and reducing alcohol use
• Regular well-baby and well-child visits, from birth to age 21
• Routine vaccinations against diseases such as measles, polio, or meningitis
• Counseling, screening, and vaccines to ensure healthy pregnancies
• Flu and pneumonia shots - Visit Vaccines.gov to learn more

Some Important Details

This preventive services provision applies only to people enrolled in job-related health plans or individual health insurance policies created after March 23, 2010. If you are in such a health plan, this provision will affect you as soon as your plan begins its first new “plan year” or “policy year” on or after September 23, 2010.

Top things to know about preventive care and services:

• Grandfathered plans: If your plan is “grandfathered,” these benefits may not be available to you.
• Network providers: If your health plan uses a network of providers, be aware that health plans are required to provide these preventive services only through an in-network provider. Your health plan may allow you to receive these services from an out-of-network provider, but may charge you a fee.
• Office visit fees: Your doctor may provide a preventive service, such as a cholesterol screening test, as part of an office visit. Be aware that your plan can require you to pay some costs of the office visit, if the preventive service is not the primary purpose of the visit, or if your doctor bills you for the preventive services separately from the office visit.
• Questions: If you have questions about whether these new provisions apply to your plan, contact your insurer or plan administrator.  If you still have questions, contact your state insurance department.
• Talk to your health care provider: To know which covered preventive services are right for you — based on your age, gender, and health status — ask your health care provider. 

For More Information

• Learn more background about the new prevention rules
• Learn about the U.S. Preventive Services Task Force recommendations
• For information on preventive practices, check out healthfinder.gov.
• Read the regulation or find detailed technical and regulatory information on prevention.

Posted on: July 1, 2010

Last updated: July 25, 2012