Now that you have health insurance, you may be wondering what’s covered and what’s not.
By law (namely, the Affordable Care Act — ACA), certain preventive services must be covered at 100%. This means no copayment, no coinsurance charge, and regardless of whether or not you have met your annual deductible.
You must receive these services from an in-network provider for your plan to cover 100% of the charge.
Preventive Services for Adults
Here is a list of the covered preventive services for adults:
| TYPE OF SERVICE | DETAILS |
|---|---|
| Abdominal Aortic Aneurysm Screening | One-time for men of specified ages who have ever smoked |
| Alcohol Misuse | Screening and counseling at physical exam |
| Aspirin Use | To prevent cardiovascular disease, for men and women of certain ages |
| Blood Pressure Screening | For all adults |
| Cholesterol Screening | For adults of certain ages or at higher risk |
| Colorectal Cancer Screening | For adults over 50 |
| Depression Screening | For all adults at physical exam |
| Type 2 Diabetes Screening | For adults with high blood pressure |
| Diet Counseling | For adults at higher risk for chronic disease |
| HIV Screening | For all adults at higher risk |
| Immunizations | As recommended (see below) |
| Obesity Screening and Counseling | For all adults during physical exam |
| Sexually Transmitted Infection (STI) prevention | For adults at higher risk |
| Tobacco Use | Cessation counseling and intervention for all adults |
| Syphilis | Screening for all adults at higher risk |
Note: Some grandfathered plans are not required to cover all services.
Immunizations for Adults
Here are the covered immunizations for adults. These are covered at 100%, with no copayment, no coinsurance charge, and regardless of whether or not you have met your deductible. The immunization must be given by an in-network provider to be covered at 100%
| IMMUNIZATIONS – VACCINES FOR ADULTS AT RECOMMENDED AGES |
|---|
| Diphtheria, Tetanus, Pertussis/Whooping Cough (DTP) |
| Hepatitis A |
| Hepatitis B |
| Herpes Zoster (Shingles) |
| Human Papillomavirus (HPV) |
| Influenza (Flu Shot) |
| Measles, Mumps, Rubella (MMR) |
| Meningococcal (Meningitis) |
| Pneumococcal |
| Varicella (Chicken Pox) |
Note: Some grandfathered plans are not required to cover all services.
Check Your Policy Information
For more detailed information, check the documentation you received with your policy. Be sure you understand what your plan covers before you seek medical treatment, so there are no surprises later!
Give our office a call or send us an email if we can answer any questions for you.
Click here for a list of preventive services and immunizations covered for children.
Click here for a list of preventive services covered for women.
