Preventative Services

All Marketplace health plans and many other plans must cover the following list of preventive services without charging you a copayment or coinsurance. This is true even if you haven’t met your yearly deductible.
These services are free ONLY when delivered by a doctor or other provider in your plan’s network.

Preventative Services for 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

Cholesterol screening for adults of certain ages or at higher risk

Colorectal cancer screening for adults over 50

Depression screening

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

Diet counseling for adults at higher risk for chronic disease

Hepatitis C screening for adults at increased risk, and one time for everyone born 1945 – 1965

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:

Lung cancer screening for adults 55 – 80 at high risk for lung cancer because they’re heavy smokers or have quit in the past 15 years

Obesity screening and counseling

Sexually transmitted infection (STI) prevention counseling for adults at higher risk

Syphilis screening for adults at higher risk

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

Preventative Services for Pregnant Women or Women Who May Become Pregnant

Anemia screening on a routine basis

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

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 to health plans sponsored by certain exempt “religious employers.” Learn more about contraceptive coverage.

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

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

Syphilis screening

Expanded tobacco intervention and counseling for pregnant tobacco users

Urinary tract or other infection screening 

Other Preventative Services for Women

Yes! Here is a list of other preventative services for women:

Breast cancer genetic test counseling (BRCA) for women at higher risk

Breast cancer mammography screenings every 1 to 2 years for women over 40

Breast cancer chemoprevention counseling for women at higher risk

Cervical cancer screening for sexually active women

Chlamydia infection screening for younger women and other women at higher risk

Domestic and interpersonal violence screening and counseling for all women

Gonorrhea screening for all women at higher risk

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 follow-up testing for women at higher risk

Sexually transmitted infections counseling for sexually active women

Syphilis screening for women at increased risk

Tobacco use screening and interventions

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

Preventative Services for Children

All Marketplace health plans and many other plans must cover the following list of preventive services for children without charging you a copayment or coinsurance. This is true even if you haven’t met your yearly deductible.

Alcohol and drug use assessments for adolescents

Autism screening for children at 18 and 24 months

Behavioral assessments for children 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 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 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 (BMI) measurements for children 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 all 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 (Whooping Cough)

Haemophilus influenzae type b

Hepatitis A

Hepatitis B

Human Papillomavirus (PVU)

Inactivated Poliovirus

Influenza (flu shot)

Measles

Meningococcal

Pneumococcal

Rotavirus

Varicella (Chickenpox)

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 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 newborns

Sexually transmitted infection (STI) prevention counseling and screening for adolescents at higher risk

Tuberculin testing for children at higher risk of tuberculosis 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