Although the Affordable Care Act (ACA) requires health insurers to cover most preventive care, the definition of this term remains unclear.

"A lot of consumers, doctors, and pharmacists don't know what's required,” says Judy Waxman, vice president of health and reproductive rights with the National Women's Law Center.

To avoid surprise costs, healthcare experts recommend that you:

  1. Know what’s covered: Under the ACA, insurance companies must cover the full cost of many preventive services, including vaccinations, cancer and other health screenings, annual well visits, breast pumps, and all FDA-approved contraceptives, based on input from a nationwide panel of primary care experts. (For a list of services covered, go to
  2. Know how your insurance company interprets these guidelines. For example, because mammograms are recommended for women over 40 every one or two years, some insurers will pay for the test annually, while other will only do so every other year.
  3. Stay in your health plan's provider network. Once you see a doctor who doesn't participate in your plan, you'll be subject to costs, even if the visit is for a preventive service that the law requires insurers to cover in full.
  4. Get to the bottom of unexpected bills. If you’re billed for a service you thought was preventive and covered in full, begin by calling your doctor’s office and then go to your health plan. If that doesn’t work, you can appeal to an independent third party. For a tool kit on preventive services, including sample appeals letters, go to The National Women's Law Center,

To learn more about this key issue, feel free to get in touch with our health insurance professionals at our agency.

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