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Preventive care coverage under the health care reform law Posted: December 19th, 2010

By Clare Kaufman

According to healthcare.gov, an estimated 7 out of 10 deaths, and 75 percent of the nation's health spending, is due to preventable medical conditions. In light of this fact, the Affordable Care Act aims to make preventive health care affordable and accessible. Effective September 23, 2010, all new health insurance policies are required by federal law to cover preventive services at no extra cost to the subscriber.

The preventive care provision

The preventive care provision of the Affordable Care Act requires all new private health plans "to cover evidence-based preventive services and to eliminate cost-sharing for preventive care." Beginning on September 23, 2010, health insurance companies will be required to cover a series of preventive services deemed effective by scientific studies. In an effort to reduce the financial barriers to health care for individuals, the health care reform law requires medical insurance companies to cover the recommended preventive services in full, without requiring a copayment, co-insurance or deductible payment.

Preventive services covered under the health care reform law

The Affordable Care Act mandates coverage for medically important, scientifically substantiated preventive services. Cancer screenings, immunizations for children and well-baby checkups are among the key preventive care services that are available free of charge to subscribers.

According to the Department of Health and Human Services, the following preventive services are covered:

Adult services

  • Cancer screening for elderly adults
  • Obesity counseling
  • Sexually transmitted infection (STI) prevention counseling
  • Cholesterol and blood pressure tests
  • Type 2 diabetes screening
  • Immunization vaccines for hepatitis, influenza, tetanus and other conditions.

Women's services, including pregnancy care

  • Cervical cancer screening
  • Breast cancer screening (mammography) and chemoprevention
  • Osteoporosis screening

Children's services

  • Autism screening
  • Behavioral assessments
  • Immunization vaccines for hepatitis, influenza, measles, rotavirus and other diseases
  • Adolescent care such as STI and substance abuse prevention counseling

Health insurance plans providing free preventive care

Under the new legislation, all new health insurance plans will be required to cover preventive care at no extra cost to the patient. Plans providing free preventive care include Medicare and Medicaid, private employer plans and individual plans. Existing health insurance plans "grandfathered" into the current system are exempt from the provision. Subscribers who choose to remain with their current health plan might not benefit from the preventive service requirement.

Preventive services are the foundation of good health. The Affordable Care Act helps Americans gain access to critical preventive services, promoting their health and reducing the long-term costs of health care.