Covered Preventive Services
The Affordable Care Act (ACA), the health care reform law passed in 2010, requires most insurance plans to cover a set of recommended preventive services at no extra cost to you. Find out about the preventive services that are recommended for you and your family.
All the recommended preventive services included in myhealthfinder are covered under the ACA. This means that if you have private insurance, you may be able to get these preventive services — like vaccines (shots), checkups, and screening tests — at no extra cost to you. Many of these services are also covered at no additional cost by Medicare and Medicaid. Check with your insurance provider to find out what’s included in your plan.
Preventive Services Recommendations and Insurance Coverage
The panels of medical experts that recommend the preventive services included in myhealthfinder meet regularly to make sure their recommendations are based on the strongest evidence.
When an expert panel makes a new recommendation for preventive services or changes an existing recommendation, private insurance companies usually have one year to update what they cover. This means that it is possible that a newly recommended service
listed in myhealthfinder may not be covered yet by your insurance plan.
There are two exceptions to the rule about the timing of coverage:
- If a new recommendation is issued too late in any calendar year, insurance companies are allowed to delay a change in coverage until the end of the following calendar year. This means that it could be more than 12 months before coverage begins.
- If the expert panels find new evidence that a preventive service may be harmful or unsafe, the U.S. Department of Health and Human Services determines the timing of the change in coverage.
Where can I find the list of preventive services most health plans must cover?
Visit HealthCare.gov for the complete list of covered preventive services. If you are still unsure if a certain preventive service is covered by your insurance plan, please contact your insurance company directly. It is also important to keep in mind that preventive services are covered at no extra cost to you only when provided by a doctor or other health care professional in your plan’s network.
What are preventive services?
Preventive services help you stay healthy. Many people think of the doctor as someone to see when they are sick. But doctors also provide services that help keep you from getting sick in the first place.
Preventive services include:
- Vaccines (shots) that protect your health by preventing diseases and other problems
- Screenings (medical tests) to check for diseases early when they may be easier to treat
- Education and counseling to help you make health decisions
What can I do if I already have insurance?
Once you have insurance, find out how to get the care you need by checking out From Coverage to Care: A Roadmap to Better Care and a Healthier You [PDF - 1 MB].
Where can I get more information about health care reform and insurance?