What Preventive Care Is Free?

by, LACIE GLOVER

Catching and treating a health problem before symptoms start, or, better yet, preventing a sickness entirely, isn’t just good for your health; it can also save you some serious money down the road.

Most chronic conditions and many serious diseases get worse over time, even with medication, but treating a disease sooner rather than later can slow its progression. Primary prevention — catching a serious or chronic condition and treating it before symptoms appear, or vaccinating to prevent a disease from ever occurring — is your best chance for a long, healthy life. And by avoiding medical care down the road, you’ll keep your costs down.

That’s why federal law requires that all health insurance plans cover specific preventive care services, including vaccinations, some disease screenings and certain types of counseling.

If your health plan is Affordable Care Act-compliant — meaning your coverage started after March 23, 2010 — you can get certain screenings and vaccinations for free if you stay within your insurance network. Here’s what they are and how to ensure you get them for free.

Covered preventive care for all adults

The law requires that insurance plans cover preventive care. The specific services covered were chosen by the U.S. Preventive Services Task Force, an independent team of 16 scientists and medical experts. Based on its recommendations, insurers must cover six basic preventive services for all adults, regardless of age, sex, plan cost or risk level.

They are:

Alcohol misuse screening and counseling.

Blood pressure screening.

Depression screening.

Obesity screening and counseling.

Tobacco use screening and counseling.

Immunizations for adults (doses, recommended ages and recommended populations vary):

Hepatitis A

Hepatitis B

Herpes zoster (shingles)

Human papillomavirus

Influenza (flu shot)

Measles, mumps, rubella

Meningococcal

Pneumococcal

Tetanus, diphtheria, pertussis

Varicella

Covered preventive care for selected groups

In addition to those screenings and vaccinations, ACA-compliant plans cover other preventive care if you’re at risk of getting certain conditions. For example, smokers and former smokers are at an increased risk for lung cancer and a specific type of aneurysm, so those screenings are covered for them at no charge. Other such screenings and care include:

Abdominal aortic aneurysm, one-time screening for men of specified ages who have ever smoked.

Aspirin use to prevent cardiovascular disease for men and women of certain ages.

Cholesterol screening for adults of certain ages or at high risk.

Colorectal cancer screening for adults over 50.

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

Diet counseling for adults at high risk for chronic disease.

Hepatitis B screening for people at high risk.

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

HIV screening for everyone 15 to 65, and other ages at increased risk.

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

Sexually transmitted infection prevention counseling for adults at high risk.

Syphilis screening for adults at high risk.

In addition to the free preventive care guaranteed to all adults, additional screenings are covered for women. These include screenings for breast and cervical cancers and selected screenings for pregnant women.

Similarly, 27 screenings and immunizations are available for free for all kids so long as you use your insurer’s provider network.

Before you get your screening

Even though these screenings are free, it doesn’t mean your entire visit will be free, because health care providers charge per service, not per visit. You may still be charged for something relating to the visit, such as a facility fee or a charge to see the doctor to discuss the results.

Most of the time, the fee is small, such as a one-time copay or 20% coinsurance. Insurers tend to keep your costs low for these sorts of fees because they understand that preventive care saves them costs down the road. To know for sure that your screening is free and to minimize additional costs, follow these steps:

Check your insurance policy summary to see what your copays are, or call the insurer’s customer service representative for specifics on the screenings you want.

Make sure the laboratory doing the testing is in your insurance network, unless you use an HMO. You can do this by calling the insurer’s customer service line to ask which labs it covers and then asking your doctor during your screening visit to send samples to one of them.

If you and your doctor decide you should have more than one screening, try to group them into as few visits as possible to reduce copays and facility fees.

Even if you are charged a copay or fee, you may find that the price to know where your health stands is well worth it.

Lacie Glover is a staff writer at NerdWallet, a personal finance website. Email: lacie@nerdwallet.com. Twitter: @LacieWrites.

This post was updated. It was originally published by NerdWallet Nov. 5, 2013.