Preventative Care
Affordable Care Act (ACA) Mandated Preventative Services
These preventive services are typically covered at no cost. This means you usually won’t have a copay or coinsurance for things like vaccines and screenings—even if your deductible hasn’t been met. Coverage may vary, and $0 cost is not guaranteed in all situations.
If your plan uses a provider network, you must visit an in-network provider to receive full coverage.
ACA preventive services may have age, gender, or other requirements. Coverage depends on these factors—check your plan for details.
FOR ALL ADULTS
- Abdominal aortic aneurysm
- One-time screening for men of specified ages who have ever smoked
- Alcohol misuse screening and counseling
- Blood pressure screening
- Cholesterol screening
- For adults of certain ages or at higher risk
- Colorectal cancer screening
- For adults 45 to 75 years
- Depression screening
- Diabetes (Type 2) screening
- For adults 40 to 70 years who are overweight or obese
- Diet counseling
- For adults at higher risk for chronic disease
- Fall prevention (exercise or physical therapy and vitamin D use)
- For adults 65 years and over, living in a community setting
- Hepatitis B screening
- For people at high risk
- Hepatitis C screening
- For adults 18 to 79 years
- HIV screening
- For everyone 15 to 65 years, and other ages at increased risk
- PrEP (pre-exposure prophylaxis) HIV prevention medication
- For HIV-negative adults at high risk for getting HIV through sex or injection drug use
- Immunizations for adults — doses, recommended ages, and recommended populations vary
- Chickenpox (Varicella)
- Diphtheria
- Flu (influenza)
- Hepatitis A
- Hepatitis B
- Human Papillomavirus (HPV)
- Measles
- Meningococcal
- Mumps
- Whooping Cough (Pertussis)
- Pneumococcal
- Rubella
- Shingles
- Tetanus
- Lung cancer screening
- For adults 50 to 80 years at high risk for lung cancer because they’re heavy smokers or quit in the past 15 years
- Obesity screening and counseling
- Sexually transmitted infection (STI) prevention counseling
- For adults at higher risk
- Statin preventive medication
- For adults 40 to 75 years at high risk
- Syphilis screening
- For adults at higher risk
- Tobacco use screening
- For all adults and cessation interventions for tobacco users
- Tuberculosis screening
- For certain adults without symptoms at high risk
FOR WOMEN
- Breastfeeding support and counseling from trained providers, and access to breastfeeding supplies
- for pregnant and nursing women
- Birth control
- Certain restrictions apply
- Folic acid supplements
- For women who may become pregnant
- Gestational diabetes screening
- For women 24 weeks pregnant (or later) and those at high risk of developing gestational diabetes
- Gonorrhea screening
- For all women at higher risk
- Hepatitis B screening
- For pregnant women at their first prenatal visit
- Maternal depression screening
- For mothers at well-baby visits
- Preeclampsia prevention and screening
- For pregnant women with high blood pressure
- Rh incompatibility screening
- For all pregnant women and follow-up testing for women at higher risk
- Syphilis screening
- Expanded tobacco intervention and counseling
- For pregnant tobacco users
- Urinary tract or other infection screening
- Bone density screening
- For all women over 65 years or women 64 years and younger who have gone through menopause
- Breast cancer genetic test counseling (BRCA)
- For women at higher risk
- Breast cancer screening mammogram, with or without clinical breast examination, every 1-2 years
- For women 40 years and older
- Breast cancer chemoprevention counseling
- For women at higher risk
- Cervical cancer screening
- Pap test (also called a Pap smear)
- For women 21 to 65 years
- Chlamydia infection screening
- For younger women and other women at higher risk
- Diabetes screening
- For women with a history of gestational diabetes
- Domestic and interpersonal violence screening and counseling
- Gonorrhea screening
- For all women at higher risk
- HIV screening and counseling
- For everyone 15 to 65 years, and other ages at increased risk
- PrEP (pre-exposure prophylaxis) HIV prevention medication
- For HIV-negative women at high risk for getting HIV through sex or injection drug use
- Sexually transmitted infections counseling
- For sexually active women
- Tobacco use screening and interventions
- Urinary incontinence screening for women yearly
- Well-woman visits to get recommended services for all women
FOR CHILDREN
- Alcohol, tobacco, and drug use assessments for adolescents
- Autism screening
- For children at 18 and 24 months
- Behavioral assessments for children
- Bilirubin concentration screening for newborns
- Blood pressure screening for children
- Blood screening for newborns
- Depression screening
- For adolescents beginning routinely at age 12
- Developmental screening
- For children under age 3
- Dyslipidemia screening
- For all children once between 9 and 11 years and once between 17 and 21 years, and for children at higher risk of lipid disorders
- Fluoride supplements
- For children without fluoride in their water source
- Fluoride varnish
- For all infants and children as soon as teeth are present
- Gonorrhea preventive medication for the eyes of all newborns
- Hearing screening
- For all newborns
- Regular screenings for children and adolescents as recommended by their provider
- Height, weight and body mass index (BMI) measurements taken regularly
- Hematocrit or hemoglobin screening for all children
- Hemoglobinopathies or sickle cell screening for newborns
- Hepatitis B screening for adolescents at higher risk
- HIV screening for adolescents at higher risk
- Hypothyroidism screening for newborns
FOR CHILDREN
- PrEP (pre-exposure prophylaxis) HIV prevention medication
- For HIV-negative adolescents at high risk for getting HIV through sex or injection drug use
- Immunizations for children from birth to 18 years — doses, recommended ages, and recommended populations vary:
- Chickenpox (Varicella)
- Diphtheria, tetanus, and pertussis (DTaP)
- Haemophilus influenza type b
- Hepatitis A
- Hepatitis B
- Human Papillomavirus (HPV)
- Inactivated Poliovirus
- Influenza (flu shot)
- Measles
- Meningococcal
- Mumps
- Pneumococcal
- Rotavirus
- Rubella
- Lead screening for children at risk of exposure
- Obesity screening and counseling
- Oral health risk assessment
- For young children from 6 months to 6 years
- Phenylketonuria (PKU) screening for newborns
- Sexually transmitted infection (STI) prevention counseling and screening
- For adolescents at higher risk
- Tuberculin testing
- For children at higher risk of tuberculosis
- Vision screening for all children
- Well-baby and well-child visits
This information is for reference only and does not guarantee the acceptance of any life event or coverage change. For more information, contact your employer's Human Resources Department or Benefits Manager, or reach out to Benefit Innovations.
