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What kinds of preventive services will my health insurance plan cover? Do they involve cost sharing?

ACA-compliant plans available both on and off the exchange are required to cover a wide range of preventive services. Services covered under these plans are broken into four major types: routine immunizations, evidence-based screening and counseling, childhood preventive services, and preventive services for women. Plans not bound by ACA restrictions, such as short-term care insurance, are not required to offer coverage for preventive services. Check the details of your plan to see what is and is not covered.

Your plan may not impose cost-sharing charges such as copayments, deductibles, or coinsurance for preventive services provided certain requirements have been met. The services must be performed by a provider from the plan’s network, must not be billed separately from the rest of the appointment, and must be the reason for the appointment. It should be noted that the rules for older, “grandfathered” plans are a bit different. These plans are not required to cover preventive services without cost sharing. If your policy was purchased prior to 2010, it may fall into this category. If you are uncertain what kind of plan you have, check with your employer (if it is an employer-sponsored plan) or the insurance company.

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