What Services Are Covered by Preventative Care Insurance?

What Services Are Covered by Preventative Care Insurance?

Preventative care insurance is covered under standard health insurance plans. It pays for preventative treatments for illnesses that could turn chronic. Over the years, many individual and corporate health plans have covered preventative care at various levels. 

However, in 2010, the Affordable Care Act (ACA) listed the preventative care services that insurance companies must pay for. This article covers the services covered by preventative care. 

What Services Will Preventive Care Insurance Pay For? 

Under the Affordable Care Act, preventative care services are classified under three buckets. They are: adults, women, and children, and the Act lists the conditions preventative coverage insurance will pay for. 

Insurance companies who offer ACA-compliant plans must pay 100% for preventative  care bills. However, if you are enrolled in a grandfathered or grandmothered plan, your fee schedule will differ from those with a different policy. This is because grandfathered and grandmothered insurance plans are subject to distinct ACA requirements. 

The following are the services covered by preventative care insurance under the three buckets:


Prevention care insurance pays for different screening tests for diverse medical conditions. Some of the illnesses covered under the three buckets are:

  • HIV screening 
  • Syphilis screening for adults at higher risk
  • Blood pressure screening 
  • Lung cancer 
  • Cholesterol screening
  • Cervical cancer screening 
  • Breast cancer mammography screening 
  • Gestational diabetes screening for women 24-28 weeks pregnant
  • Dyslipidemia screening for children between ages 1-17 at higher risk for lipid disorders
  • Hemoglobinopathies or sickle cell screening for newborns, etc.


Some medications are taken to prevent certain illnesses from occurring. Therefore, if you take, for instance, aspirin to reduce blood clots and lessen the risk of cardiovascular disease, preventative care insurance will cover the payment. 


Preventative care insurance also covers immunization, but ensure you check with your insurer to meet the recommended age and population. 


Preventative care insurance will pay for your counseling if you have an addiction or are part of an age group at risk of a chronic illness. 

What About Wellness Programs?

Some insurance company preventative care plans cover wellness programs. However, they are more common with an employer or employer-sponsored health insurance policies. The wellness program coverage motivates policyholders to live a healthier lifestyle, reducing their chances of getting sick. 

If you want a customized preventative care insurance plan that is ACA-compliant as part of your health insurance policy, we can help. Our team at Goldstein Healthcare will help present you with different competitive insurance policies and guide you to make the right choice. Contact us now to get a free quote, and click here for more information.