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Health Care Reform:

Health Insurance & Affordable Care Act

Well-Child Visits: What Health Reform Covers

Your children need regular preventive care from a doctor, sometimes called wellness visits or well-child visits. Getting this kind of care when they are young can help children have a better quality life as they grow up.

The Affordable Care Act makes sure every child gets the health care he or she needs. Health care reform uses guidelines set by the American Academy of Pediatrics as the blueprint for children's health care. Those guidelines call for:

  • Regular checkups from birth through age 21
  • Scheduled immunizations
  • Screenings for childhood diseases

You do not have to pay a copay for this care because it is preventive care. The Affordable Care Act makes insurance companies cover these services for children with no cost to you.

Well-Child Visits

Your children will do best if you make sure they get well-child visits on a regular basis. This should start even before they're born. As a mom-to-be, you are entitled to a prenatal visit. That gives you a chance to talk to a doctor about breastfeeding, child safety, and newborn care.

Well-child visits should follow this schedule:

  • Right after your baby is born
  • At 1 week old
  • At 1 month old
  • At 2 months old
  • At 4 months old
  • Every three months from 6 months old to 2 years old
  • At 2 1/2 years old
  • Every year from 3 years old until age 21

Your child will get a basic checkup at these doctor visits. The doctor also will do health screenings and give any shots that the child needs. These visits for preventive care can be separate from other appointments.

Under the Affordable Care Act, you will not be charged for well-child visits. But you may have a copay or deductible for other care your child needs.

Other Child Health Benefits

You and your child also have other benefits under health care reform:

Your children must be covered by your health plan if you choose to include them. This applies even if a child has a pre-existing condition.

The amount of money you pay out-of-pocket for medical care and prescriptions is capped. This starts in 2014. It means there's a maximum amount you'll have to pay. You'll have less financial worry from paying to treat a child with a serious illness.

Your children's care will not be limited. That's because health reform did away with yearly and lifetime limits for insurance coverage. This means that children with a chronic illness can get care as long as it is needed.

Your children will get essential health benefits. All new plans must cover certain items and services, including doctor's office visits, prescription medications, screenings and vaccines, services to help with injuries or disabilities, and, for children, dental and vision care.

Exceptions to Availability

If your children are already covered under Medicaid, they will get preventive care. This is also true if you buy a plan through your state's insurance Marketplace. The Children's Health Insurance Program, called CHIP, also offers this. CHIP will continue at least through 2019.

However, your children might not be covered if you have an older "grandfathered" health plan that existed and hasn't changed much since 2010 when the Affordable Care Act became a law. These older plans do not have to offer free preventive care. Some of them may, though, so always read a plan's summary of benefits before you enroll in it.

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