Many ACA-compliant health plans cover a wide range of preventive services at no additional cost when you use an in-network provider. Learn what’s included and why preventive care can help you stay healthier while avoiding larger medical bills later.
Preventive Care Can Help You Stay Healthy
One of the biggest advantages of an Affordable Care Act (ACA) health plan is access to preventive care.
These services are designed to detect health issues early, help prevent disease, and keep you healthier over time. In many cases, they’re covered without a deductible, copayment, or coinsurance, provided you receive them from an in-network provider and the service qualifies as preventive under your plan. Coverage can vary, so it’s always a good idea to verify your benefits before scheduling care.
What is Preventive Care?
Preventive care focuses on maintaining your health before serious problems develop.
Depending on your age, medical history, and individual risk factors, covered preventive services may include:
- Annual wellness visits
- Blood pressure screenings
- Cholesterol screening
- Diabetes screening
- Depression screening
- Colorectal cancer screening
- Lung cancer screening for eligible individuals
- Certain immunizations
- Counseling for tobacco cessation
- Obesity screening and counseling
- Hepatitis and HIV screening for eligible individuals
Your doctor can help determine which preventive services are appropriate for you.
“No Cost” Doesn’t Always Mean Everything is Free
This is where many people become confused.
Your annual preventive visit may be covered at no cost, but if your doctor evaluates a new medical problem, orders diagnostic testing because of symptoms, or provides treatment beyond the preventive service, those additional services may be billed separately according to your plan’s normal cost-sharing rules.
Understanding the difference can help avoid unexpected bills.
Preventive Care is an Investment in Your Health
Preventive care isn’t just about saving money.
Regular screenings and vaccinations can help detect health conditions earlier, when treatment is often simpler and more effective. Taking advantage of the preventive benefits included with your health plan can be one of the easiest ways to protect both your health and your finances.
MATRIX TIP
Many people delay preventive care because they assume they’ll have to pay their deductible first. That’s often not the case.
If you haven’t had your annual preventive visit, contact your primary care provider and ask whether it’s covered as a preventive service under your health plan. It could help identify health concerns early while costing you little or nothing out of pocket.
Have questions about your Marketplace or Medicare coverage? We’re happy to help you understand your options and make informed decisions about your health insurance.
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Official Guidance
This article is based on information published by HealthCare.gov regarding preventive services covered under Affordable Care Act health plans.
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