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  • What is considered “Preventive Services” that are covered at 100% under Health Care Reform?

     Now is the time to stay healthy with “FREE” preventive care services!

    Preventive health care–including annual physical exams, screenings, and immunizations–is essential to good health. Yet many Americans don’t receive the regular preventive care they need, despite the fact that chronic diseases, which are responsible for 7 of 10 deaths among Americans each year and account for 75% of the country’s health care spending–are often preventable.

    Why do so few Americans get the preventive care they need? Often, the reason is cost.

    The Affordable Care Act (health care reform) attempts to address this problem by requiring all new group and individual health insurance plans as of September 23, 2010 to pay 100% of the costs for preventive care services ranked A and B by the U.S. Preventive Services Task Force (USPSTF) .

    If your health plan qualifies, you can take advantage of a wide range of preventive care services to help you avoid illness and improve your health–at no cost to you, so long as you receive these services from a health care provider within your health plan’s network of doctors and hospitals.

    You won’t have to pay a copayment at the office visit, and not a penny toward coinsurance or your deductible. Doctors and health care facilities continue to charge for these services. But now it’s the health insurance companies that pay the costs. Essentially, preventive care becomes ‘free’ for the policyholder, greatly increasing the incentive to take advantage of these services. The following lists outline the preventive care services covered by these rules for adults, women, and children.

    Adults

    Covered preventive services for adults include:

    • Abdominal aortic aneurysm
    • A one–time screening for men of specified ages who have ever smoked
    • Colorectal cancer screening
    • Depression screening for adults
    • Type 2 diabetes screening
    • Diet counseling for adults at higher risk for chronic disease 
    • HIV screening for all adults at higher risk  
    • Immunization vaccines for adults (recommendations vary):
      • Hepatitis A
      • Hepatitis B
      • Herpes zoster
      • Human papillomavirus
      • Influenza (flu shot)
      • Measles, mumps, rubella
      • Meningococcal
      • Pneumococcal
      • Tetanus, diphtheria, pertussis
      • Varicella
    • Obesity screening and counseling for all adults
    • Sexually transmitted infection (STI) prevention counseling for adults at higher risk 
    • Tobacco use screening for all adults and cessation interventions for tobacco users 
    • Syphilis screening for all adults at higher risk

    Women

    Women Covered preventive care services for women, including pregnant women, include:

    • Anemia screening on a routine basis for pregnant women
    • Bacteriuria urinary tract or other infection screening for pregnant women
    • BRCA (breast cancer gene) counseling about genetic testing for women at higher risk
    • Breast cancer mammography screenings every one to two years for women over 40
    • Breast cancer chemoprevention counseling for women at higher risk
    • Breastfeeding comprehensive support and counseling from trained providers, as well as access to breastfeeding supplies, for pregnant and nursing women*
    • Cervical cancer screening for sexually active women
    • Chlamydia infection screening for younger women and other women at higher risk
    • Contraception : Food and Drug Administration–approved contraceptive methods, sterilization procedures, and patient education and counseling, not including abortifacient drugs*
    • Domestic and interpersonal violence screening and counseling for all women*
    • 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
    • Human immunodeficiency virus (HIV) screening and counseling for sexually active women*
    • Human papillomavirus (HPV) DNA test : High–risk HPV DNA testing every three years for women age 30 or older* with normal cytology results
    • Osteoporosis screening for women over 60, depending on risk factors
    • Rh blood incompatibility screening for all pregnant women and follow–up testing for women at higher risk
    • Tobacco use screening and interventions for all women, and expanded counseling for pregnant tobacco users
    • Sexually transmitted infections (STI) counseling for sexually active women*
    • Syphilis screening for all pregnant women or other women at increased risk
    • Well–woman visits to obtain recommended preventive services for women under 65*

    Note: Services marked with an asterisk (*) must be covered with no cost–sharing in plan years starting on or after August 1, 2012.

    Children
    Covered preventive care services for children include:

    • Alcohol and drug use assessments for adolescents 
    • Autism screening for children at 18 and 24 months 
    • Behavioral assessments for children of all ages 
    • Blood pressure screening for children 
    • Cervical dysplasia screening for sexually active females 
    • Congenital hypothyroidism screening for newborns 
    • Depression screening for adolescents
    • Developmental screening for children under age 3, and surveillance throughout childhood 
    • Dyslipidemia screening for children at higher risk of lipid disorders 
    • 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 measurements for children 
    • Hematocrit or hemoglobin screening for children 
    • Hemoglobinopathies or sickle cell screening for newborns 
    • HIV screening for adolescents at higher risk 
    • Immunization vaccines for children from birth to age 18 (recommendations vary): o
      • Diphtheria, tetanus, pertussis
      • Haemophilus influenzae type B
      • Hepatitis A
      • Hepatitis B
      • Human papillomavirus
      • Inactivated poliovirus
      • Influenza (flu shot)
      • Measles, mumps, rubella
      • Meningococcal
      • Pneumococcal
      • Rotavirus
      • Varicella 
    • 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
    • Obesity screening and counseling
    • Oral health risk assessment for young children
    • Phenylketonuria (PKU) screening for this genetic disorder in newborns
    • Sexually transmitted infection (STI) prevention counseling and screening for adolescents at higher risk
    • Tuberculin testing for children at higher risk of tuberculosis
    • Vision screening for all children

    It’s important to keep in mind that while the health plan cannot charge you a copayment, deductible, or coinsurance when the primary purpose of the office visit is the recommended preventive care service and the service is NOT billed separately from the office visit, you may be required to share some of the costs if the preventive service is not the primary purpose of the office visit. And remember, preventive services are covered at 100% only when received from health care providers within the health plan’s network. For the most up–to–date list of covered preventive care services, please visit http://www.uspreventiveservicestaskforce.org

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