Which Preventive Services and Immunizations Are Covered for Children Under ACA?

Now that you have health insurance, you may be wondering what’s covered and what’s not for your dependent child(ren).

By law (namely, the Affordable Care Act — ACA), certain preventive services for children through age 18 must be covered at 100%.  This means no copayment, no coinsurance charge, and regardless of whether or not you have met your annual deductible.

Your child must receive these services from an in-network provider for your plan to cover 100% of the charge.

Preventive Services for Children

Here is a list of the preventive services that must be covered for children ages 18 and under:

TYPE OF SERVICE	DETAILS
Alcohol and Drug Use Assessment	For adolescents ages 11-18.
Autism Screening	At ages 18 months and 24 months
Behavioral Assessments	At ages 0-11 months, 1-4 years, 5-10 years, 11-14 years, 15-17 years
Blood Pressure Screening	For children at recommended ages: 0-11 months, 1-4 years, 5-10 years, 11-14 years, 15-17 years
Congenital Hypothyroidism Screening	Once at birth
Cervical Dysplasia Screening	For sexually active females
Depression Screening	For adolescents
Developmental Screening	For children under age 3; continued monitoring throughout childhood
Dyslipidemia Screening	For children at higher risk for lipid disorders at ages 1-4 years, 5-10 years, 11-14 years, 15-17 years
Fluoride Supplements	For children without fluoride in their water source
Gonorrhea Preventive Medication	For all newborns, once at birth
Hearing Screening	For all newborns
Height, Weight, Body Mass Index	For children at ages 0-11 months, 1-4 years, 5-10 years, 11-14 years, 15-17 years
Hematocrit or Hemoglobin Screening	For children
HIV Screening	For adolescents at higher risk
Immunizations	As recommended (see below)
Iron Supplements	For children ages 6-12 months at risk for iron deficiency (anemia)
Lead Screening	For children at risk of exposure
Medical History	For all children throughout development
Obesity Screening and Counseling	For all children
Oral Health Risk Assessment	For young children at ages 0-11 months, 1-4 years, 5-10 years
Phenylketonuria (PKU) Screening	For newborns
Sexually Transmitted Infection (STI) Prevention Counseling and Screening	For adolescents at higher risk
Tuberculosis (TB) Testing	For all children at higher risk
Vision Screening	For all children

Note: Some grandfathered plans are not required to cover all services.

Immunizations for Children

Here are the covered immunizations for children up to age 18.  These are covered at 100%, with no copayment, no coinsurance charge, and regardless of whether or not you have met your deductible.  The immunization must be given by an in-network provider to be covered at 100%

IMMUNIZATIONS – VACCINES FOR CHILDREN AT RECOMMENDED AGES
Diphtheria, Tetanus, Pertussis/Whooping Cough (DTP)
Haemophilus Influenza Type B
Hepatitis A
Hepatitis B
Human Papillomavirus (HPV)
Influenza (Flu Shot)
Measles, Mumps, Rubella (MMR)
Meningococcal (Meningitis)
Pneumococcal
Polio (Inactivated Poliovirus)
Rotavirus
Varicella (Chicken Pox)

Note: Some grandfathered plans are not required to cover all services.

Check Your Policy Information

For more detailed information, check the documentation you received with your policy.  Be sure you understand what your plan covers before you seek medical treatment, so there are no surprises later!

Give our office a call or send us an email if we can answer any questions for you.

Click here for a list of preventive services and immunizations covered for adults.

Click here for a list of preventive services covered for women.