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What are preventive benefits and how are they covered?

Preventive benefits are designed to keep people healthy by providing screening for early detection of certain health conditions or to help prevent illnesses. The ACA requires that all plans except grandfathered plans cover many preventive services with no out-of-pocket costs (meaning no deductiblescoinsurance, or copayments). Some of these covered preventive services are:

  • Colorectal cancer screenings, including polyp removal for individuals over age 50
  • Immunizations and vaccines for adults and children
  • Counseling to help adults stop smoking
  • Blood pressure screening for adults
  • Cholesterol and diabetes screening for certain adults
  • Well-woman checkups, as well as mammograms and cervical cancer screenings
  • Well-baby and well-child exams for children

Unless an insurer does not have an in-network provider to perform a particular preventative service, plans are permitted to charge for these preventative services when performed by an out-of-network provider.

For more detailed information about covered preventive services, visit the federal government's website.

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