Understanding Preventive Health Care Under Obamacare

What is Preventive Health Care?

Visiting your doctor when you’re sick is a no-brainer, but checking in when you’re healthy may also be important. Even when you’re not experiencing any health issues, there are services your doctor can provide that can potentially help prevent future problems.

This kind of medical service is called preventive health care, and the goal is to assess your current health and detect the early warning signs of illness. Key components of preventive care can include annual exams, health screenings, and immunizations.

How does Obamacare cover preventive services?

With Obamacare, all major medical individual and family health insurance plans are required to cover a broad range of preventive medical services. In many cases, Obamacare covers preventive medical services at no out-of-pocket cost to you. It’s important to understand precisely which preventive care services are covered without cost.

What qualifies as “free” preventive medical care under Obamacare?

Let’s look at what sorts of preventive health care services Obamacare will not require you to pay for out of your own pocket. It’s important to remember that these services may only be free when delivered by a doctor or other provider in your health insurance plan’s network.

Obamacare health insurance plans will generally cover one annual checkup at no cost. At this annual checkup, your doctor will decide on any tests or health screenings that are appropriate based on your personal health history and your current health condition.

Even if you haven’t met your yearly deductible, Obamacare health insurance plans may often cover the following without any cost to you*:

• Screenings for the following conditions:
  • Abdominal aortic aneurysm
  • Misuse of Alcohol
  • Blood Pressure
  • Cholesterol
  • Colorectal & lung cancer
  • Depression
  • Hepatitis B & C
  • HIV
  • Syphilis
  • Tobacco
  • Type 2 Diabetes
• Counseling for:
  • Alcohol Abuse
  • Diet
  • Prevention of sexually transmitted infections (STI)
• Other Benefits:
  • Aspirin for cardiovascular disease prevention
  • The following vaccines:
    • Diphtheria
    • Hepatitis A & B
    • Herpes Zoster
    • Human Papillomavirus (HPV)
    • Influenza (flu shot)
    • Measles
    • Meningococcal
    • Mumps
    • Pertussis
    • Pneumococcal
    • Rubella
    • Tetanus
    • Varicella (Chickenpox)

Women often have special health needs. Here’s a summary of additional preventive medical services for women that are typically covered at no out-of-pocket cost by Obamacare-compliant health insurance plans:

• Screenings for the following conditions and risk factors:
  • Breast cancer genetic test (BRCA) and mammograms
  • Cervical cancer
  • Chlamydia & Gonorrhea
  • Domestic and interpersonal violence
  • Human Papillomavirus (HPV) DNA test
  • Osteoporosis
  • Rh incompatibility
• Counseling for:
  • Breast cancer chemoprevention
  • Domestic violence
  • Sexually transmitted infections
• For women under age 65, an annual well women visit for:
  • Discussing health history and habits
  • Physical exam

Here are some additional preventive medical services that may be covered by Obamacare plans at no out-of-pocket cost for pregnant women or women who may become pregnant:

• Screenings for the following conditions and risk factors:
  • Anemia
  • Gestational diabetes
  • Gonorrhea
  • Hepatitis B
  • Rh incompatibility
  • Syphilis
  • Urinary tract infection
• Other Benefits:
  • Counseling, supplies, and support for breastfeeding
  • Education and counseling for FDA approved contraceptive methods and sterilization procedures
  • Folic acid supplements
  • Pregnant tobacco users receive expanded intervention and counseling

Here’s a list of preventive medical services for children which are generally covered at no out-of-pocket cost by Obamacare-compliant health insurance plans:

• Assessments and screenings:
  • Adolescent drug and alcohol use
  • Autism
  • Behavior
  • Blood pressure
  • Cervical dysplasia
  • Child development
  • Depression
  • Dyslipidemia
  • Hearing
  • Height, weight and body mass index (BMI)
  • Hematocrit or hemoglobin
  • Hemoglobinopathies or sickle cell
  • Hepatitis B
  • HIV
  • Hypothyroidism
  • Lead
  • Obesity
  • Oral health
  • Phenylketonuria (PKU)
  • Tuberculin
  • Vision
• The following vaccines:
  • Diphtheria, Tetanus, Pertussis (Whooping Cough)
  • Haemophilus influenza type b
  • Hepatitis A & B
  • Human Papillomavirus (HPV)
  • Inactivated Poliovirus
  • Influenza (flu shot)
  • Measles
  • Meningococcal
  • Pneumococcal
  • Rotavirus
  • Varicella (Chickenpox)
• Other Benefits:
  • Fluoride chemoprevention supplements
  • Gonorrhea preventive medication for newborns’ eyes
  • Iron supplements when at risk for anemia
  • Adolescents sexually transmitted infection (STI) prevention counseling

What doesn’t qualify for free preventive care under Obamacare?

Generally speaking, you need to get the services described above from a doctor or medical service provider that is covered by your insurance plan – otherwise it may not be covered, even under Obamacare health insurance plans. There may be basic qualifying criteria needed to justify providing you with some of the free preventive services described above. For example, you may need to be a woman in some cases, or to be older (or younger) than a certain age, or to have a family medical history that meets certain criteria.

If you go to see the doctor for an annual check, that checkup itself may be free – but if the doctor orders tests based on a medical diagnosis he or she makes during that visit, those tests may not be considered preventive care and may require you to pay out of pocket (copayments, deductibles, etc).

Additional information on preventive health care under Obamacare

If you’ve been putting off your annual checkup or some other kind of preventive medical care, take advantage of your Obamacare coverage. Prior to 2014, when major provisions of the Obamacare law came into effect, many of the preventive services described above were not covered by all health insurance plans. Preventive health care not only to keeps you healthy, but also can lower your medical costs in the future through early diagnosis and treatment.

* Source for all preventive services listed in this article: https://www.healthcare.gov/coverage/preventive-care-benefits/