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Preventive services —What’s covered?

Doctor examining patient in hospital

Under the Affordable Care Act certain preventive services, such as mammograms and annual physicals, are covered at 100 percent. In general, preventive services fall into three categories: screenings, vaccinations, and annual checkups. Common screenings include mammograms, colonoscopies, and Pap tests.

 

Common vaccines include tetanus, diphtheria and pertussis (Tdap), the flu shot, and shingles vaccines. So what if during a routine exam, your doctor finds something that requires further testing or treatment? In most cases additional services for injury or illness are covered, but there may be a cost. In other words, you pay for these services just like any other service under your plan.

 

Let’s say your doctor is giving you an annual checkup. There is no copayment and no coinsurance to you for that checkup. However, during the checkup, the doctor discovers that you have a rash on the back of your leg. The doctor would like to get a sample and send it to the lab. The lab procedure and any fees from the lab are now subject to coinsurance, which you will be billed for. If it turns out you need to go to a dermatologist for your rash, you would have to pay a copayment and any coinsurance for services you need from the dermatologist.

 

For a complete list of all preventive services covered at 100 percent, visit www.healthcare.gov/what-are-my-preventive-care-benefits/.