Affordable Care Act: Preventive Health for Women

Whether you just want an annual physical exam or are having a baby, the Affordable Care Act requires most health insurance plans* to cover a wide range of preventive health services for women. Here's a look at some of the services that are covered without copays, coinsurance, or deductibles. Check your policy’s benefits for details, because specific coverage is different from plan to plan.

Heart disease prevention. You can get regular blood pressure and cholesterol screenings for free. If you have high blood pressure, you can also get screening for type 2 diabetes. You should get blood pressure screening at least every 2 years, starting when you're 18. If you have high blood pressure, you will need to be checked more often. If you’re a woman over age 45 at increased risk, you should have your cholesterol checked at least every 5 years. If you have any condition that raises your risk of heart disease, start the cholesterol checks at age 20.

To keep your heart in good shape:

Cancer services. Early screening tests for breast cancer, cervical cancer, and colorectal cancer are covered. This includes:

  • Mammograms to check for breast cancer every 1-2 years for women over age 40.
  • Pap smear every 3 years for women ages 21 to 65 to check for cervical cancer. After age 30 your doctor may add HPV testing. How often you need these tests may change depending on your risk.
  • Colorectal cancer screening for women ages 50 to 75. Some tests are done every 1 to 2 years. Others are done every 5 to 10 years.

Breast cancer prevention for women at high risk. If you’re at high risk, you can get support a few ways. First, you can get genetic testing and counseling to help you make important choices about treatment. Also, drugs to help prevent breast cancer may be covered with no copays or deductibles when your doctor prescribes them.

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Tobacco use. You can get help quitting smoking or using tobacco. Most health care plans cover screening, where your doctor will ask if you smoke or use tobacco and then talk to you about quitting. Coverage under the Affordable Care Act may include free programs to help you stop smoking as well as stop-smoking drugs and nicotine replacement therapy.

Osteoporosis. Women over age 65 now don’t have to pay for osteoporosis screening tests; younger women may qualify too, depending on their chances of getting bone disease. To help keep your bones strong, it's important to do regular weight-bearing exercises (like hiking, tennis), muscle-strengthening exercises (like lifting weights, using exercise bands), and flexibility exercises (like stretching).

Pregnancy care. When you're having a baby, most plans cover, without copays, coinsurance, or deductibles, screening tests for anemia, gestational diabetes, hepatitis B, the blood problem known as Rh incompatibility, and urinary tract infections. Most also cover folic acid supplements as prescribed by a provider and prenatal visits.

Contraception. All FDA-approved methods of birth control, as well as counseling on how to use contraception, are covered under most health care plans. . This includes diaphragms, sponges, birth control pills, IUDs, and more. For more details, ask your doctor. You’ll need a prescription, even for those that are normally sold over the counter. Some religious employers are exempt from having to provide this coverage.

Other conditions. Most health care plans also cover, free of charge:

  • HIV screening tests and counseling
  • Counseling for sexually transmitted infections if you are at increased risk
  • Domestic and intimate partner violence screening and counseling

Well-woman visits. Most health care plans cover your annual doctor's visit to help you get the preventive care and tests you need to stay healthy. More than one well-woman visit per year may be covered, if needed.

* Grandfathered health plans, those that existed before the Affordable Care Act was passed and have not significantly changed, are not required to offer weight loss counseling. Check with your insurance company or HR department to find out if you’re in a grandfathered plan. In addition, short-term health plans do not have to offer these benefits. Short-term health policies are those in effect for less than 12 months, although they can be renewed for up to 3 years.

 

WebMD Medical Reference Reviewed by Sarah Goodell on September 17, 2018

Sources

SOURCES:

Health Resources and Services Administration: "Women's Preventive Services Guidelines."

HealthCare.gov: "What are my preventive care benefits?"

HealthFinder.gov: "Get your cholesterol checked" and "Get your blood pressure checked."

National Osteoporosis Foundation: "Calcium and Vitamin D: What You Need to Know" and "Exercise for Strong Bones."

U.S. Preventive Services Task Force.

WhiteHouse.gov: "How the Affordable Care Act Improves the Lives of American Women."

WomensHealth.gov: "Make the Call, Don't Miss a Beat" and "Talk with a Doctor if Breast or Ovarian Cancer Runs in Your Family."

 

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