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Preventive Care

Covered California Preventive CarePreventive care aims to help detect and prevent small health problems before becoming big health risks. It is a provision in the Patient Protection and Affordable Care Act (PPACA) whose purpose is to keep people healthier by removing cost barriers for preventive care services and to lower health care costs overall.

Because of Obama Care in California, preventive care is now free on most plans.  This means these specific services are not subject to the deductible and you do not have to pay a co-pay or any co-insurance. This is true of all private non-grandfathered health plans that became effective September23, 2010 or after. In addition, there are specific free preventive services for women on plans that became effective August1, 2012 or after.

Preventive Care Services

For all adults

  • Blood pressure screening
  • Certain immunizations
  • Cholesterol screening for adults of certain ages or at higher risk
  • Colorectal cancer screening for adults over 50
  • Diabetes (Type 2) screening for adults with high blood pressure

For women

  • Breast cancer mammography screenings every 1- 2 years for women over 40
  • Cervical cancer screening for sexually active women
  • Contraception and contraceptive devices
  • Osteoporosis screening for women over age 60 depending on risk factors
  • Well-woman visits to get recommended services for women under 65 including preconception care, prenatal care and breastfeeding support and equipment

For children

  • Behavioral assessments for certain age ranges through age 17
  • Certain immunizations
  • Hearing screening for all newborns
  • Height, weight and body mass index (BMI) measurements for certain age ranges through age 1
  • Oral health risk assessments for children of certain age ranges through age 10
  • Vision screening for all children

When Preventive Care Services Are Not Free

Preventative services are not free if obtained through an out-of-network provider. If the primary reason of your office visit is for diagnostic care, then you most likely will have to pay. This means that if the majority of your visit addresses health problems you are already having, then your visit is not a preventive care visit. It can also depend on how your doctor’s office codes the visit. If the preventive service is billed separately from the office visit, the preventive service must be free, but the office visit may have a cost. If you receive treatment given as a result of a preventive service visit but the actual treatment itself is not considered a preventive service, then you may have to pay.

How to Make Sure Your Preventive Care Services are Free

  • Make sure you visit in-network doctors and providers
  • When scheduling your appointment, make sure to say it’s for your free annual preventative care exam
  • At the appointment, ask your doctor to code your service as a preventive care visit
  • If you need a more costly service such as a colonoscopy, ask a number of providers how the service will be billed before you make your appointment, and work with your insurance company to find out how to obtain most if not all of the service for free