Are Private Health Insurance Plans Covering Preventive Care Services?

Most health plans are required by law to provide a range of preventive services, such as vaccines and screenings, at no cost to the patient. This includes health insurance plans taken out through an employer, as well as those purchased on the individual's own through the Health Insurance Marketplace. It is important to note that the doctor providing the service must be in the network for full coverage. These preventive care procedures and visits include annual physical exams, flu shots, and vaccines.

Additionally, some states have their own mandates on free preventive care. The Departments of Health and Human Services, Labor and the Treasury issued new regulations requiring private health plans to cover evidence-based preventive services and eliminate the cost-sharing of preventive care. This is essential for maintaining health, as it helps identify health problems early and builds on other provisions of the Affordable Care Act (ACA) that support prevention. Under section 2713 of the ACA, private health plans must provide coverage for a variety of recommended preventive services and cannot impose cost-sharing (such as copays, deductibles, or coinsurance) on patients who receive these services. This includes contraceptives and mammograms with no co-pays. Individual and family medical and dental insurance plans are insured by Cigna Health and Life Insurance Company (CHLIC) and Cigna HealthCare of Arizona, Inc., while group health insurance and health benefit plans are insured or administered by CHLIC, Connecticut General Life Insurance Company (CGLIC) or their affiliates.

The ACA's preventive services mandate covers most people who have private health insurance, either through their employer or the public purse. Individual and small group plans in the health insurance markets must also cover an essential health benefits (EHB) package that includes the full range of preventive requirements described in this fact sheet. It has been more than ten years since the Affordable Care Act (ACA) required private insurance plans to cover recommended preventive services without patients sharing the costs. If you have questions about which tests you can expect to be covered and which aren't, be sure to ask your doctor or health insurance provider. eHealth employees are also available to quickly answer any other questions you may have about preventive care and health insurance in general.

Tommy Gair
Tommy Gair

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