Free Preventive Services

Under the Affordable Care Act (ACA) of 2010, most health plans must cover certain preventive services at no cost to you. You don’t have to pay a copay or coinsurance for those services and your deductible doesn’t apply. Those are forms of cost sharing by which you normally pay for part of your healthcare.

To prevent any surprises in getting your preventive services, make note of these points:

• Stay in network. The preventive services are free only when you get them from a doctor or other provider in your health plan’s network. Those are the providers who have agreed to accept your plan’s contracted rate as payment in full for their services. Make sure the provider who gives you the service is in your plan’s network.
• Related services may not be free. Even though a particular screening or other service is free, related services may not be. For example, suppose you get a colorectal cancer screening for free. You still may have to pay at your usual cost-sharing rates for the anesthesia services provided with the screening. Check with your insurer in advance to find out what is and isn’t covered for free. Also, if a problem is found and treated at the time of the screening test (e.g., a biopsy is performed), it’s no longer considered screening but diagnostic and therapeutic. In such a situation, the procedure may be subject to deductibles, coinsurance and other out-of-pocket costs.
• Some older plans may be exempt from the law. The plans that have to provide these free services include new health plans created after the ACA was signed. They also include plans that have changed their coverage since then. Older plans that have stayed the same since the law was signed are considered “grandfathered.” There are probably few such plans now. But, to be sure yours isn’t one of them, check your plan documents or ask your employer or insurance company representative.
• Not every preventive service is free. The law doesn’t require health plans to cover every kind of preventive service for free. For example, plans don’t have to cover an annual physical exam or checkup for everyone for free. Even so, many insurers do cover an annual checkup for free. Talk to your doctor about whether you’ll need to get one and what cost, if any, would apply.

The ACA breaks into three categories the types of preventive services that must be covered for free. The categories are all adults, women and children. For full details, see HealthCare.gov’s information here. This is a brief sampling of the services:

• For all adults. Based on age and other risk factors, services include screening for a number of diseases, such as colorectal cancer, depression and type 2 diabetes. Services also include blood pressure, cholesterol and obesity screening; vaccines; and tobacco use screening with an intervention to help tobacco users quit.
• For women. Some services are specifically for pregnant women or women who may become pregnant, such as breastfeeding support and counseling, birth control (with some exceptions) and folic acid supplements. Others are for all women, depending on age and other risk factors, such as annual well-woman visits, breast cancer mammographies and screenings for osteoporosis.
• For children. Some services are meant to be given throughout childhood, including behavioral assessments and vision screening. Others are intended for specific age groups, such as alcohol and drug use assessments for adolescents, or for other specific risk factors. Standard childhood vaccines are covered, such as those for measles, diphtheria and polio.

Workplace Wellness Programs

Many employers offer workplace wellness programs, such as dietary counseling, stress management, substance abuse control and on-site exercise. Some employers may offer financial incentives—such as reducing the health coverage premiums deducted from your paycheck—or other rewards to employees who take part in wellness programs. Ask your employer if such a program is offered at your workplace.