Free Preventive Care Services Covered in Marketplace Health Plans

Free Preventive Care Services Covered in Marketplace Health Plans

The Affordable Care Act (ACA) required health care insurance providers to completely cover the costs of certain preventive services. Preventive medicine is the practice of avoiding disease in the future. Personal preventive care includes having a healthy diet and lifestyle, avoiding risky behavior like smoking and excessively drinking. Preventive healthcare services can include screenings for common disorders and counseling for medical conditions.  

You can receive free preventive care services if you have coverage under one of the Marketplace health insurance policies. Some services only become free once you reach a certain age or have a relevant history.

To obtain medical services free of charge, you must go to a health care provider in your insurance plan’s network. Services that normally have no cost may not have a fee if you go to an out-of-network provider. 

If you are interested in taking advantage of the free preventive care services available, continue reading the information below. You can also speak to a representative of your insurance provider. 

Types of Preventive Care Services at No Cost

A preventive health screening assesses if you are at risk for a medical condition. Your risk probability for certain diagnoses can increase with age. Likewise, your lifestyle or genetics could make you more prone to certain illnesses. 

Your doctor may prescribe a preventive screening once you reach a certain age or present signs of increased risk. Here are some examples of free preventive screenings for adults: 

  • Blood pressure
  • Cholesterol
  • Cancer
  • Diabetes
  • Hepatitis B or C
  • HIV and other sexually transmitted infections
  • Tuberculosis

You can also receive certain vaccinations for immunization against viruses, such as mumps, measles, and rubella. These ACA preventive care services need to be widely available for public safety concerns. 

Free services extend further than physical preventive care meaning you can obtain emotional services, like a depression screening. You may also receive counseling for:

  • Tobacco cessation.
  • Obesity and diet.
  • Fall prevention.
  • Alcohol misuse.

Your PCP may also speak to you about fall prevention if you are getting older, take certain medication, or have a condition that affects your mobility or balance. 

In addition to medical services and counseling, your ACA-compliant health insurance policy may cover preventive medications. For example, high-risk adults may get statin preventive medication that reduces the risk of stroke and heart attacks. 

Medicaid, Medicare and Preventive Services

The Centers for Medicare and Medicaid Services (CMS) operates the two health care plans in compliance with the ACA’s minimum essential coverage (MEC) requirements. 

Like Marketplace health plans, the programs’ coverage includes preventive and wellness services. CMS preventive services include the same listed.

In fact, individuals newly enrolled Medicare can schedule a “Welcome to Medicare” preventive visit with their doctor free of charge. Your doctor can get a baseline of your health and wellbeing to discuss your wellness plan moving forward. 

As for Medicaid, the program must cover preventive services for newly eligible adults. However, the state where you live can influence if those services are completely free. Children enrolled in Medicaid for children or CHIP, will have many more preventive services covered.  

Free Medical Services Based on Age or Sex

Some no-cost preventive services are only free once you reach a certain age. For instance, diabetes screenings are free when you are overweight and between 40 and 70 years of age.

Women 40 years of age or older can get a free mammogram every one to two years. However, if you need a mammogram because of a lump, it is no longer considered a preventive service, but rather a diagnostic service. Similarly, women have more covered preventive services than men, particularly pregnant women. Here are some women’s preventive care examples:

  • Anemia screenings
  • Folic acid supplements
  • Rh incompatibly screenings
  • Gestational diabetes screenings
  • Breastfeeding support and counseling
  • Well-woman visits
  • Domestic violence screenings and counseling

Women can get free cervical cancer screenings (Pap smear) every three years when they are between 21 and 65 years of age. Women at higher risk for breast cancer can also get genetic counseling and chemoprevention counseling at no cost.

Your Free Annual Physical Exam

Each year, you can have a wellness checkup with your Primary Care Physician (PCP) without any out-of-pocket expenses. However, there may be costs if your PCP recommends additional tests or services based on the wellness checkup.

During an annual physical exam, your PCP will: 

  • Gather your past medical and family history.
  • Conduct a physical examination relevant to your age, sex, and acknowledged risk factors. 
  • Check your weight and vitals. 
  • Provide counseling on age-appropriate risk factors. 

Marketplace insurance plans also cover several preventive tests. Ask your PCP about these free screenings during your annual checkup. 

While your annual physical exam is free, other doctor’s visits may have fees, like copays. Costs for visits based on an illness or medical problem are based on your specific policy.

Your PCP may also talk to you about your plan to stay healthy in the upcoming 365 days until your next annual exam. If your doctor discovered high blood pressure or cholesterol, for example, he or she might recommend altering your diet or taking medication. 

Preventive Health Services for Children

The ACA gives children much more free preventive health services. For instance, parents can ask for an autism screen for their children when they are 18 and 24 months old. 

Newborns can receive free blood and hearing screenings as well as gonorrhea prevention medication. Some children’s preventive care examples: 

  • Developmental screenings for kids younger than 3 years old to ensure they are reaching growing milestones 
  • Oral health risk assessments, fluoride chemoprevention supplements, and fluoride varnish
  • Immunizations for whooping cough, HPV, meningococcal, and more
  • Body mass index measurements to make sure children are within the weight standard for their height and age
  • Sexually transmitted illness screenings in those that are sexually active
  • Vision screening
  • Iron supplements for infants at risk for anemia

Adults get one free wellness checkup annually. However, babies and young children need to see pediatricians and other medical professionals more frequently. 

Marketplace insurance policies should cover well-baby and well-child visits. The frequency of free visits depends on your child’s age.