WPS Health Insurance Blog

Preventive health services available for women at no cost

Posted by Ryan Kanable

Oct 7, 2016 8:36:56 AM

Woman-doctor-visit.jpgLadies, this blog is for you. Did you know there are more than a dozen preventive health services that, under the Affordable Care Act, you can get at no cost? That means there’s no longer a financial excuse to avoid the doctor. If you’re not using these services, you’re missing out.

All health plans sold on the Marketplace, and many other plans, must cover certain preventive services for women without charging a copayment or coinsurance—even if you haven’t met your yearly deductible. Keep in mind, however, that they are only free when delivered by a doctor or other provider in your health plan’s network. If you go out of network, you’ll be paying for the service.

Back in 2012, the Institute of Medicine (now called the National Academies of Sciences, Engineering, and Medicine) put together a list of services that promote women’s health. It includes well-woman visits, screenings, counseling, and breastfeeding support and supplies. The list gets reviewed periodically, and right now, there’s talk of expanding it.

The final recommendations will be submitted to the Health Resources and Services Administration, part of the Department of Health and Human Services, by Dec. 1. If the HRSA adopts the recommendations before the end of this year, they would go into effect for most health plans at the beginning of 2018.

Here are the items currently recommended by HRSA:

Services for women who are pregnant or may become pregnant:

  1. Anemia screening on a routine basis
  2. Breastfeeding comprehensive support and counseling from trained providers, plus access to breastfeeding supplies, for pregnant and nursing women
  3. Contraception: Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling, as prescribed by a health care provider for women with reproductive capacity (not including abortifacient drugs). This does not apply to health plans sponsored by certain exempt “religious employers.” Learn more about contraceptive coverage.
  4. Folic acid supplements for women who may become pregnant
  5. Gestational diabetes screening for women 24 to 28 weeks pregnant and those at high risk of developing gestational diabetes
  6. Gonorrhea screening for all women at higher risk
  7. Hepatitis B screening for pregnant women at their first prenatal visit
  8. Rh incompatibility screening for all pregnant women and follow-up testing for women at higher risk
  9. Syphilis screening
  10. Expanded tobacco intervention and counseling for pregnant tobacco users
  11. Urinary tract or other infection screening

Preventive services:

  1. Breast cancer genetic test counseling (BRCA) for women at higher risk
  2. Breast cancer mammography screenings every one to two years for women over 40
  3. Breast cancer chemoprevention counseling for women at higher risk
  4. Cervical cancer screening for sexually active women
  5. Chlamydia infection screening for younger women and other women at higher risk
  6. Domestic and interpersonal violence screening and counseling for all women
  7. Gonorrhea screening for all women at higher risk
  8. HIV screening and counseling for sexually active women
  9. Human Papillomavirus (HPV) DNA test every three years for women with normal cytology results who are 30 or older
  10. Osteoporosis screening for women over age 60 depending on risk factors
  11. Rh incompatibility screening follow-up testing for women at higher risk
  12. Sexually transmitted infections counseling for sexually active women
  13. Syphilis screening for women at increased risk
  14. Tobacco use screening and interventions
  15. Well-woman visits to get recommended services for women under 65

Proposed enhancements

If the list of covered preventive services is expanded, women would see increased coverage for breast and cervical cancer screenings, more robust support for breastfeeding, gestational diabetes mellitus screening, HIV screening, interpersonal and domestic violence screening and counseling, and more. It would also include broader coverage of contraceptives, perhaps even for men. You can read more about the Women’s Preventive Services Initiative here.

Whether or not the new services are adopted, if you’re a woman, your health may benefit from seeing your doctor and putting these preventive benefits to use. Don’t know which screenings to get? Try our online tool for help.

Topics: health insurance, Wellness