Don't Miss Out on Coverage for Preventive Care

You give your health a lot of time and thought. Things you do today for yourself can help you out in the future. That includes preventive care.

Depending on your insurance policy, you may not have to pay to get those services. As part of the Affordable Care Act, all non-grandfathered health plans must offer the following preventive care at no cost to you at the time of the visit.

If you have a grandfathered health plan, which is one that existed before March 2010 and has made few changes to its benefits and costs, it doesn’t have to offer these services without asking you to share in the cost. But some grandfathered health plans cover preventive services at no cost to you. Check your insurance policy for details.

No matter what kind of insurance policy you have, though, your age, gender, and health status can affect the types of preventive services that are covered.

Look at your plan's summary of benefits to see if you can get the services on the following list without extra cost. You can also use the list to know what kinds of services your doctor may offer. There are separate lists, too, just for women and children. You can find links to them on healthcare.gov/preventive-care-benefits.

Abdominal Aortic Aneurysm Screening Test for Men

What it does: Uses an ultrasound to look for an aneurysm, or bulging, in the main artery in the abdomen, called the aorta. If an aneurysm gets too large, it can burst and lead to death.

How often: One time for men ages 65 to 75 who have smoked at any time in their lives. The preventive health guidelines don't recommend a screening for women or for men who have never smoked.

Alcohol Misuse Screening Test and Counseling

What it does: Looks for drinking problems in adults 18 and older by asking a series of questions. If you have trouble controlling the amount of alcohol you drink, you'll also receive free, brief behavioral counseling to help you cut back or quit drinking alcohol.

How often: At your physical exam each year.

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Evaluate Need for Preventive Aspirin

What it does: Checks to see if a small daily dose of aspirin can help you prevent heart disease and stroke.

How often: At your physical exam each year, if you're between the ages of 50 and 69, ask your doctor about the benefits of aspirin.

Blood Pressure Test

What it does: Checks for high blood pressure, which increases the chance of having heart disease and strokes, in adults ages 18 and older.

How often: Every yearfor those ages 40 and older or those who are at risk for high blood pressure. Risk factors include high-normal blood pressure (130-139/85-89), being overweight or obese, and being African-American. Adults ages 18-39 with normal blood pressure and without other risk factors should be screened every 3 to 5 years.

Cholesterol Test

What it does: Measures levels of cholesterol in your blood to evaluate your chance of developing heart disease and having a stroke. For the test, you give a small sample of blood, preferably after fasting for about 12 hours.

How often: Every 5 years for adults ages 20 and older who are at increased risk of coronary heart disease; all men over the age of 35. If your cholesterol is high, you'll be monitored more frequently.

Colorectal Cancer Test

What it does: Your doctor has several ways to check you for colon and rectal cancer. Some tests, such as the fecal occult blood test (FOBT), check for blood in your stool. Other tests, such as a colonoscopy, look for abnormal growths in your colon and rectum.

How often: After age 50 and until age 75, your doctor may recommend a colonoscopy every 10 years. Other options are a yearly FOBT or a sigmoidoscopy, which also checks the rectum but only the lower colon, every 5 years. If you have a family history of colon or rectal cancer or if your doctor says you have a higher risk for another reason, you may need to be checked more often.

Depression Screening Test

What it does: Checks for signs of depression in adults by asking a series of questions.

How often: At your physical exam each year.

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Type 2 Diabetes Test

What it does: Uses one or more small samples of your blood to check for type 2 diabetes. It's recommended if you're age 40-70 and are overweight or obese or you’re younger than 40 but are at high risk for type 2 diabetes.

How often: At your physical exam each year.

Nutrition Counseling

What it does: Helps people at risk for chronic diseases make healthy food choices and lower their risk for health problems related to diet, such as:

  • Heart disease
  • Type 2 diabetes
  • High blood pressure
  • Some cancers
  • Bone loss

How often: At your physical exam each year. The counseling can be from a primary care doctor, nutritionist, dietitian, or other specialist.

HIV Test

What it does: Uses a small sample of your blood to test for HIV, an infection that can lead to AIDS.

You also may get counseling before and after the test to help you:

  • Learn about the HIV test
  • Learn how to prevent HIV
  • Learn what your test results mean

How often:

  • At least once in your lifetime between the ages of 15 and 65.
  • When you're pregnant.
  • At least once a year if you have other risk factors for HIV

You doctor can help you decide how often is appropriate for you.

Immunization Vaccines

What they do: Protect against certain diseases:

  • Hepatitis A
  • Hepatitis B
  • Herpes zoster (shingles)
  • Human papillomavirus (HPV)
  • Influenza (flu shot)
  • Measles, mumps, rubella
  • Meningococcal
  • Pneumococcal (pneumonia shot)
  • Tetanus, diphtheria, pertussis
  • Varicella (chickenpox)

How often: You can get a flu shot each year. You get other vaccines at certain ages as a booster or as needed depending on your chances of having the disease.

Obesity Screening Test and Counseling

What it does: Checks your body mass index (BMI) to see if your weight is unhealthy based on your height. If you have a BMI of 30 or higher, you'll also get free diet counseling.

How often: At your physical exam each year.

Health plans may offer telephone counseling, health coaches, group sessions, or referrals to Weight Watchers. Your doctor or other experts may give you guidance. 

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Sexually Transmitted Disease (STD) Prevention Counseling

What it does: Teaches adults at risk how to avoid STDs. This prevention counseling also helps you know if you should be tested for STDs.

How often: At your physical exam each year.

Syphilis Test

What it does:  Checks your blood for syphilis.

How often: At your annual physical exam for people at high risk for syphilis. A pregnant woman gets this test at her first prenatal exam.

Tobacco Use Screening Test

What it does:  It asks a series of questions. If you smoke or use other forms of tobacco, you may get free counseling to help you kick the habit.

How often: At your physical exam each year. Health plans have a lot of flexibility in what they offer for counseling.

WebMD Medical Reference Reviewed by Sarah Goodell on September 30, 2017

Sources

SOURCES:

Healthcare.gov: "What are my preventive care benefits?" "What if I have a grandfathered plan?" "Preventive Health Services for Adults."

Healthfinder.gov: "Talk to Your Doctor About Abdominal Aortic Aneurysm," "Talk With Your Doctor About Taking Aspirin Every Day," "Get Your Blood Pressure Checked," "Get Your Cholesterol Checked," "Get Tested for Colorectal Cancer," "Eat Healthy," "Get Tested for HIV," "Get Important Shots," "Get Tested for Chlamydia, Gonorrhea, and Syphilis."

U.S. Preventive Services Task Force: "USPSTF A and B Recommendations," "Screening and Behavioral Counseling Interventions in Primary Care to Reduce Alcohol Misuse."

American Academy of Family Physicians: "Recommendations by Topic: Clinical Preventive Services."

Agency for Healthcare Research and Quality: "Guide to Clinical Preventive Services, 2012."

Women's Health.gov: "Syphilis Fact Sheet."

CDC: "National Cholesterol Education Month."

Detroit Free Press: "Obamacare requires most insurers to tackle obesity," July 4, 2014.

American Lung Association: "Tobacco-Related Provisions of the Affordable Care Act."

 

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