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The Affordable Care Act and Preventative Health: What services can get and how much are they going to cost you?

April 25th, 2014

The M

Credit: Keoni Cabral via Flickr Under Creative Commons

Things have been a little quiet in the world of the Affordable Care Act, as of late. Mostly this is due to the ending of the legislation’s first open enrollment period, which ran from the start of October 2013 until the end of March 2014. There were plenty of things wrong with this first open enrollment period, and hopefully they’ve ironed out the major bugs in the system for the next one which begins in November 2014.

In the mean time we at ForHealthInsurance.com have taken it upon ourselves to help you get up to speed and ready for the 2015 open enrollment season with a series of articles updating and reminding you about the different aspectes of the ACA and what to look for when enrolling.

This week’s topic is Preventative Care Benefits.

 

What are Preventive Care Benefits?

One of the things that makes the ACA a unique piece of legislation is that it goes beyond simply looking to reform the American health care system. The ACA is attempting to reform the way Americans look at their health.

Americans are sick. The prevalence of preventable, chronic diseases, like diabetes, obesity, and heart disease has never been higher in this country. Seven out of every ten deaths in America can be linked to chronic diseases, according to numbers from the Centers for Disease Control. Just imagine how much those diseases are costing the American health care system, not to mention the economy in the form of lost productivity.

Through that lense it’s no wonder the ACA is making such an attempt to prevent and reverse the damage chronic diseases cause among the American population. The big way the ACA is attempting this is through the inclusion of mandated preventive health services in all health insurance exchange plans.

These are services to help you stay ahead of developing any sort of serious chronic disease. They’re also there to help you give up bad habits, like smoking, that can lead to massive health complications down the road.

 

So what services do you get?

Here below are the lists of preventive health services covered by every health insurance exchange plan sold under the ACA. These service are offered by your health insurance provider with no copays, or coinsurance. This holds true if you haven’t met your yearly deductible amount yet. So essentially as long as you’re paying your monthly premiums these services are free for you to use, though there are some limits on how frequently you can make use of them as described below.

Health insurance exchange plans are required to offer at least 15 different preventive health services to adults between the ages of 18 and 65. For children up to the age of 18 they receive 26 different preventative health service, and women receive 22 until the age of 65.

Here they are listed out according to HealthCare.gov:

 

Adults:

  • Abdominal Aortic Aneurysm one-time screening for men of specified ages who have ever smoked

  • Alcohol Misuse screening and counseling

  • Aspirin use to prevent cardiovascular disease for men and women of certain ages

  • Blood Pressure screening for all adults

  • Cholesterol screening for adults of certain ages or at higher risk

  • Colorectal Cancer screening for adults over 50

  • Depression screening for adults

  • Diabetes (Type 2) screening for adults with high blood pressure

  • Diet counseling for adults at higher risk for chronic disease

  • HIV screening for everyone ages 15 to 65, and other ages at increased risk

  • Immunization vaccines for adults–doses, recommended ages, and recommended populations vary:

    • Hepatitis A

    • Hepatitis B

    • Herpes Zoster

    • Human Papillomavirus

    • Influenza (Flu Shot)

    • Measles, Mumps, Rubella

    • Meningococcal

    • Pneumococcal

    • Tetanus, Diphtheria, Pertussis

    • Varicella

  • Obesity screening and counseling for all adults

  • Sexually Transmitted Infection (STI) prevention counseling for adults at higher risk

  • Syphilis screening for all adults at higher risk

  • Tobacco Use screening for all adults and cessation interventions for tobacco users

 

Women:

  • Anemia screening on a routine basis for pregnant women

  • Breast Cancer Genetic Test Counseling (BRCA) for women at higher risk for breast cancer

  • Breast Cancer Mammography screenings every 1 to 2 years for women over 40

  • Breast Cancer Chemoprevention counseling for women at higher risk

  • Breastfeeding comprehensive support and counseling from trained providers, and access to breast feeding supplies, for pregnant and nursing women

  • Cervical Cancer screening for sexually active women

  • Chlamydia Infection screening for younger women and other women at higher risk

  • Contraception: Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling, as prescribed by a health care provider for women with reproductive capacity (not including abortifacient drugs). This does not apply tohealth plans sponsored by certain exempt “religious employers.”

  • Domestic and interpersonal violence screening and counseling for all women

  • Folic Acid supplements for women who may become pregnant

  • Gestational diabetes screening for women 24 to 28 weeks pregnant 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

  • HIV screening and counseling for sexually active women

  • Human Papillomavirus (HPV) DNA Test every 3 years for women with normal cytology results who are 30 or older

  • Osteoporosis screening for women over age 60 depending on risk factors

  • Rh Incompatibility screening for all pregnant women and follow-up testing for women at higher risk

  • Sexually Transmitted Infections counseling for sexually active women

  • Syphilis screening for all pregnant women or other women at increased risk

  • Tobacco Use screening and interventions for all women, and expanded counseling for pregnant tobacco users

  • Urinary tract or other infection screening for pregnant women

  • Well-woman visits to get recommended services for women under 65

 

Children:

  • Autism screening for children at 18 and 24 months

  • Behavioral assessments for children at the following ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years.

  • Blood Pressure screening for children at the following ages: 0 to 11 months, 1 to 4 years , 5 to 10 years, 11 to 14 years, 15 to 17 years.

  • Cervical Dysplasia screening for sexually active females

  • Depression screening for adolescents

  • Developmental screening for children under age 3

  • Dyslipidemia screening for children at higher risk of lipid disorders at the following ages: 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years.

  • Fluoride Chemoprevention supplements for children without fluoride in their water source

  • Gonorrhea preventive medication for the eyes of all newborns

  • Hearing screening for all newborns

  • Height, Weight and Body Mass Index measurements for children at the following ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years.

  • Hematocrit or Hemoglobin screening for children

  • Hemoglobinopathies or sickle cell screening for newborns

  • HIV screening for adolescents at higher risk

  • **Hypothyroidism screening for newborns

  • Immunization vaccines for children from birth to age 18 —doses, recommended ages, and recommended populations vary:

    • Diphtheria, Tetanus, Pertussis

    • Haemophilus influenza type b

    • Hepatitis A

    • Hepatitis B

    • Human Papillomavirus

    • Inactivated Poliovirus

    • Influenza (Flu Shot)

    • Measles, Mumps, Rubella

    • Meningococcal

    • Pneumococcal

    • Rotavirus

    • Varicella

  • Iron supplements for children ages 6 to 12 months at risk for anemia

  • Lead screening for children at risk of exposure

  • Medical History for all children throughout development at the following ages: 0 to 11 months, 1 to 4 years , 5 to 10 years ,11 to 14 years , 15 to 17 years.

  • Obesity screening and counseling

  • Oral Health risk assessment for young children Ages: 0 to 11 months, 1 to 4 years, 5 to 10 years.

  • Phenylketonuria (PKU) screening for this genetic disorder in newborns

  • Sexually Transmitted Infection (STI) prevention counseling and screening for adolescents at higher risk

  • Tuberculin testing for children at higher risk of tuberculosis at the following ages: 0 to 11 months, 1 to 4 years, 5 to 10 years,11 to 14 years, 15 to 17 years.

  • Vision screening for all children.

To learn more about preventative services and the various offerings of the new health insurance exchanges under the Affordable Care Act, visit our Exchange Center and our blog.