Preventive Benefits

Last updated: October 7, 2015

What Are They and How Are They Covered?

Preventive benefits are designed to keep people healthy. They provide screening for early detection of certain health conditions and to help prevent illnesses.

The Affordable Care Act (ACA) requires that plans (except grandfathered plans) cover many preventive services. They must cover them with no out-of-pocket costs (meaning no deductibles, copayments, and coinsurance).

Some of these covered preventive services are:

  • Colorectal cancer screenings (including polyp removal for individuals over age 50)

  • Immunizations and vaccines (for adults and children)

  • Counseling to help adults stop smoking

  • Blood pressure screening for adults

  • Cholesterol and diabetes screening for certain adults

  • Well-woman checkups (as well as mammograms and cervical cancer screenings)

  • Well-baby and well-child exams for children

Unless an insurer does not have an in-network provider to perform a particular preventative service, plans are permitted to charge for these preventative services when performed by an out-of-network provider.

For more detailed information about covered preventive service, visit the federal government’s website at:

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