Now that you have health insurance, you may be wondering what’s covered and what’s not, specifically for women.
By law (namely, the Affordable Care Act — ACA), certain preventive services for women 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 all services listed on this page from an in-network provider for your plan to cover 100% of the charge.
Preventive Services for Women
Below is a list of the preventive services that must be covered at 100% for women. These services are in addition to covered preventive services for all adults. (See below for additional covered services for pregnant women):
| TYPE OF SERVICE | DETAILS |
|---|---|
| BRCA Counseling – Genetic Testing | For women at high risk |
| Breast Cancer Screenings (Mammogram) | Every 1-2 years for women over 40 |
| Breast Cancer Counseling | For women at high risk |
| Contraception | For FDA-approved methods of contraception and sterilization procedures; also includes education and counseling |
| Domestic Violence and Interpersonal Violence Screening and Counseling | For all women |
| HIV Screening and Counseling | For sexually active women |
| Osteoporosis Screening | For women over age 60 or with certain risk factors |
| Pap and HPV Test (Cervical Cancer Screening) | Every 3 years ages 30+ with normal results |
| Sexually Transmitted Infection (STI) Screening and Counseling — Chlamydia, Gonorrhea, Syphilis | For women at high risk |
| Well-woman Visits | For all women |
Note: Some grandfathered plans are not required to cover all services.
Preventive Services for Pregnant Women
Below is a list of the preventive services that must be covered at 100% for pregnant women.
| TYPE OF SERVICE – PREGNANT WOMEN | DETAILS |
|---|---|
| Anemia Screening | On a routine basis |
| Bacterium Screening with Urine Culture | For pregnant women |
| Breastfeeding Support, Supplies, Counseling (Including Access to Breastfeeding Equipment) | For pregnant and nursing women |
| Gestational Diabetes Screening | For women 24 – 28 weeks pregnant and those with high risk for gestational diabetes |
| Hepatitis B Screening | At first prenatal visit |
| HIV Screening | For all pregant women |
| Rh Incompatibility Screening | At first prenatal visit, with follow-up for women at high risk |
| Sexually Transmitted Infection (STI) Screening and Counseling for Syphilis | For all pregnant women |
Note: Some grandfathered plans are not required to cover all services.
Review Your Policy Documentation
It’s always a good idea to review your plan information for specifics of what is covered under your specific policy. While the above services must be covered at 100%, many other services are also covered at the levels defined in your plan.
If you have any questions about your coverage, you can give our office a call or send us an email.
Click here for a list of preventive services and immunizations covered for children.
