What’s covered under the Affordable Care Act

Many Kansans are new to shopping for health insurance on the individual or family market this year. Understanding coverage with the Affordable Care Act (ACA) can be different than the group coverage you are familiar with.

The ACA provides health insurance by making it possible for anyone, regardless of their current or previous health condition, to purchase health insurance. It mandates that all plans offered on the Marketplace (healthcare.gov) include the same essential health benefits and preventive services.

This is not a complete listing of covered services and services may change. Always refer to your member benefit description when you enroll in a plan. Your plan will include information on what doctor or other provider is covered in your plan’s network to receive these services.

Additional benefits may be available depending on your plan. For details about the 10 essential health benefits, visit healthcare.gov.

Preventive services

Preventive services can help keep you and your family healthy. These are services that some consumers can receive without any cost-sharing, meaning they will not pay deductibles, copays or co-insurance for the preventive services examples listed here. Remember to check your plan’s network for details.

Preventive services for adults

  • Blood pressure screening
  • Cholesterol screening for adults of certain ages or at higher risk, and coverage for certain statins in adults 40 to 75 years old at increased risk for cardiovascular disease
  • Colorectal cancer screening for adults 50 to 75 years old
  • Type 2 diabetes screening for adults with high blood pressure
  • Routine immunizations (doses, recommended ages and recommended populations vary)

Preventive services for women including pregnant women

  • Anemia screening on a routine basis for pregnant women
  • Breast cancer genetic test (BRCA) counseling for women at higher risk for breast cancer
  • Breast cancer mammography screenings
  • Cervical cancer screening
  • Gestational diabetes screening for women 24 to 28 weeks pregnant and those at high risk of developing gestational diabetes
  • Human papillomavirus (HPV) testing every three years for women who are 21 and older
  • Osteoporosis screening for women over age 60 depending on risk factors

Preventive services for children

  • Dental fluoride supplementation for children without fluoride in their water source
  • Dental fluoride varnish for infants and children
  • Hearing screening for all newborns and for children once between 11 and 14 years, once between 15 and 17 years, and once between 18 and 21 years
  • Depression screening for adolescents
  • Immunization vaccines for children from birth to age 18 (doses, recommended ages and recommended populations vary)
  • Oral health assessment for young children
  • Vision screening

The ACA Open Enrollment Period is Nov. 1 through Dec. 15. For a complete listing of preventive services covered, visit healthcare.gov.

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