Understanding the Affordable Care Act: Preventive Services Benefits

One of the changes from the Affordable Care Act is related to certain types of care called preventive services. These services include regular physical examinations, immunizations and certain medical screening tests that have proven to promote health and wellness and help prevent illness.

Under the Affordable Care Act, you and your family may be eligible to receive these recommended preventive health services without having to pay a deductible, coinsurance or copay when you see a doctor in your network.

Some of the preventive services that may be available to you and your family at no additional cost include:

  • Blood pressure, diabetes, cholesterol and depression screenings
  • Many preventive cancer screenings, including mammograms and colorectal cancer screening
  • Counseling on topics like 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, chicken pox and flu
  • Annual well-woman visits, including cervical cancer screening and Pap smear
  • Counseling, screening and vaccines to ensure healthy pregnancies

Some important things to remember about receiving preventive services under your insurance coverage:

  • Grandfathered plans: If your insurance plan is "grandfathered," you may not receive these services at no cost. Grandfathered plans are individual policies or group health plans that were issued before the Affordable Care Act passed and so may not have all the law's new benefits at this time.
  • Network providers: If your health plan uses a network of doctors and hospitals, your plan only needs to provide preventive services at no cost through doctors or hospitals that are in the network. You may be allowed to receive the services from out-of-network doctors or hospitals, but you may be charged your regular cost-sharing fee.
  • Office visit fees: Your doctor may provide a preventive service, such as a cholesterol screening test, as part of an office visit. You can be required to pay some costs of the office visit.

If you have questions about whether your health insurance plan provides preventive services without cost sharing, call the customer service number on the back of your member ID card. It is a good idea to check before you go to your doctor's appointment.