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What Is Preventive Health Insurance and What Does It Cover?

Preventive health insurance is a plan that provides coverage for medical care to prevent an illness. Considering the past data, a majority of the health plans have provided coverage for preventive care at different levels. After the ACA or Affordable Care Act came into existence, all health plans are now supposed to provide coverage for visits to a doctor for preventive care and examinations. The consumer is not required to pay a single penny. The insurance companies are legally bound to offer such benefits for medical services. All this falls under the preventive category, for instance, your annual physical checkup. There are many health plans like PPO plans that offer 100 percent coverage in case of preventive care. However, having an in-network provider is essential. Here are the details.

What Do Preventive Healthcare Services Cover?

Preventive care is basically of three categories: children, women, and adults. There is a list of preventive services for each of these categories. As per the Affordable Care Act, these services have full coverage. If you have signed up for a grandmother or grandfathered plan, you need to keep track of the fee schedules since the same ACA requirements don’t apply to these plans. Take a look.

For All Adults

This category includes anyone who is above the age of 18. This applies to adults over 50. The list of screenings includes:

  • Blood pressure screening.
  • Depression screening.
  • Alcohol misuse screening.
  • Hepatitis B screening.
  • Type 2 diabetes screening.
  • Hepatitis C screening.
  • Colorectal cancer screening.

The insurance also covers cholesterol screening for people who belong to a certain age group or have high cholesterol, one-time screening of abdominal aortic aneurysm for men of a certain age who have been smokers. Besides that, it also covers HIV screening for anyone aged 15-65, lung cancer screening for people aged in the range of 55 to 80 who are chain smokers or have been smokers in the past, syphilis screening, obesity screening, etc.

Medications include aspirin to prevent cardiovascular disease for women and men belonging to a certain age group. Immunizations are offered for hepatitis A, hepatitis B, influenza, and HPV or human papillomavirus. The doses recommended populations, and recommended ages vary. Coverage should also be offered for alcohol misuse counseling, obesity counseling, diet counseling for those with a higher risk of chronic disease, STI prevention counseling, smoking cessation counseling, etc. Discuss with your insurance provider to know whether the expenses will be covered.

For Women

Preventive care for women falls under two categories: care for all women and care for pregnant women or those who may become pregnant. There is breast cancer genetic test counseling, breast cancer mammography screenings, breast cancer chemoprevention counseling, cervical cancer screening, and chlamydia infection screening for all women categories. You can also get domestic and interpersonal violence screening and counseling, gonorrhea screening, HIV screening and counseling, HPV DNA test, osteoporosis screening, STI counseling, syphilis screening, tobacco use screening, etc.

For others, there is anemia screening, breastfeeding support, and counseling. The insurance also covers the Food and Drug Administration, gestational diabetes screening, hepatitis B screening, syphilis screening, expanded tobacco intervention and counseling, urinary tract infection screening, etc. Besides that, it also includes supplies to help breastfeeding women, the sterilization process, contraceptive methods, education, and counseling.

For Children

This preventive care is for anyone who is below the age of 18. Screenings include autism screening for babies between 18 and 24 months. Besides that, it also includes behavioral assessments, blood pressure screenings, depression screening, cervical dysplasia, developmental screening, depression screening, and hearing screening for a newborn baby.

The insurance also covers dyslipidemia screening, height, weight, BMI measurements, and alcohol and drug use assessment. Not forget the insurance also covers hepatitis B screening, HIV screening, hemoglobin screening, hypothyroidism screening, lead screening, obesity screening, and oral health risk assessment. It also includes STI screening, PKU or phenylketonuria screening, vision screening, and tuberculin testing.

Medications include iron supplements for babies aged 6 to 12 months, medication to prevent gonorrhea for a newborn’s eyes, fluoride chemoprevention supplements, etc. Immunization doses are given for hepatitis A, hepatitis B, human papillomavirus, pertussis, tetanus, diphtheria, and influenza. Additional services are also offered, such as obesity counseling and STI prevention counseling for teenagers. Aside from that, medical history through a child’s developmental ages is available.

As long as your health insurance provider is an in-network one, you must receive coverage for preventive services. Even your dependents need not pay anything for preventive care.

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