The Affordable Care Act (ACA) has made preventive care free for health insurance policyholders, so it's smart to know what care you'll need when.
What is preventive care?
According to Dr. Michael Gill, an internist at Loyola University Chicago Medical Center, "preventive care is geared toward preventing problems that one, are common, and two, you can do something about."
The ACA requires health insurance plans -- including group plans from employers and individual plans sold inside and outside the marketplaces -- to cover a list of preventive care services through in-network providers with no cost sharing, according to HealthCare.gov. That means the services are free, with no copays or coinsurance, even if you haven't yet met your deductible.
So what preventive care services should you use? That depends on you, says Dr. Joseph Pinzone, CEO and medical director of AMAI, a medical and wellness practice in Santa Monica, Calif. But, it's important for just about everybody to get screened for the diseases that kill the most people, he says. These diseases fall into three categories, he says:
- Cardiovascular disease, which can lead to heart attacks and stroke.
- Metabolic conditions such as diabetes.
Here's the care you should be able to get for free.
8 types of preventive care all adults should get
1. Blood pressure testing for all adults 18 and older.
2. Cholesterol check for men starting at 35 and women at 45. Finding out about high cholesterol early can help patients work with their doctors to prevent bigger problems in the future, Gill says. For patients at increased risk for heart disease, cholesterol screening is recommended starting at age 20. According to the U.S. Preventive Services Task Force, factors that increase risk include diabetes, tobacco use, high blood pressure, obesity and family history.
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3. Routine immunizations. Vaccinations such as Hepatitis A and B, shingles, HPV, and others are covered based on federal age and frequency guidelines. Recommendations change frequently, so talk to your doctor about what shots you need, Gill says. "Folks over 65 should definitely think about getting pneumonia and shingles shots," he says.
4. HIV screening for patients age 15 to 65.
5. Sexually transmitted infection, or STI, counseling and screening for some adults. STI counseling and syphilis and gonorrhea testing are covered for adults at higher risk. "That's always a tricky and touchy subject," Gill says, adding that a doctor should talk with a patient to gauge their risk level. According to the U.S. Preventive Services Task Force, patients at higher risk include men who have sex with men, commercial sex workers and inmates at adult correctional facilities.
6. Depression screening.
7. Obesity screening and counseling. Many adults don't get the help they need for obesity, Pinzone says, noting that follow-up care is essential. Patients typically need help from other health professionals such as a dietician, personal trainer and psychologist, Pinzone says.
8. Diabetes screening for some adults. Diabetes screening is recommended for adults with high blood pressure.
9. Tobacco use screening and stop-smoking programs. Most doctors ask patients, "Do you smoke?" but the screening often ends there, Pinzone says, adding that follow-up care to help smokers stop is crucial.
10. Colorectal cancer screening with tests such as colonoscopy or sigmoidoscopy (a procedure that looks into the sigmoid colon and rectum) from age 50 to 75. Depending on risk factors such as family history, a doctor might recommend starting these tests at an earlier age, Pinzone says.
"It's something you don't have to do very often," Gill says, noting that patients with normal results can wait about 10 years before having another test.
6 types of preventive care for women
Health insurance plans must cover a separate list of preventive services for women. These include:
- Well woman visits for women younger than 65.
- Cervical cancer screening for sexually active women 21 to 65. Recommendations have recently changed so women with normal Pap test and negative results for human papillomavirus (HPV) can get re-tested every three years.
- Contraception, with some exemptions for religious employers.
- A variety of services for pregnant women. These include hepatitis B testing, anemia screening, gestational diabetes testing, syphilis screening and urinary tract infection testing.
- Mammograms every one to two years for women older than 40. "Early detection makes breast cancer so much more easily treatable," Gill says.
- Osteoporosis screening for women older than 60.
Preventive care for men
Wellness care for men includes:
1. Aneurysm testing: Men 65 and older who have a history of smoking should get a one-time ultrasound test to check for abdominal aortic aneurysms. Many patients don't know about this recommendation, Gill says. The test is important because an aortic aneurysm "will kill you if it explodes," he says. "You've got about five minutes to get to the ER."
2. Use of aspirin for some men age 45 to 79 to prevent heart attacks. However, the risk of gastrointestinal bleeding from the aspirin must be considered, according to the U.S. Preventive Services Task Force.
Preventive care should be "very individualized," Pinzone says, noting that your doctor is the expert on what you need when.