Preventive care benefits for children

Most health plans must cover a set of preventive health services for children at no cost. This includes Marketplace and Medicaid coverage.

Notice:

IMPORTANT
These services are free only when delivered by a doctor or other provider in your plan’s network.

Coverage for children’s preventive health services

All Marketplace health plans and many other plans must cover the following list of preventive services for children without charging you a copayment  or  coinsurance

. This is true even if you haven’t met your yearly  deductible.

1. Alcohol, tobacco, and drug use assessments for adolescents
2. Autism screening for children at 18 and 24 months
3. Behavioral assessments for children: Age 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years
4. Bilirubin concentration screening (PDF, 609 KB) for newborns
5. Blood pressure screening for children: Age 0 to 11 months, 1 to 4 years , 5 to 10 years, 11 to 14 years, 15 to 17 years
6. Blood screening for newborns
7. Depression screening for adolescents beginning routinely at age 12
8. Developmental screening for children under age 3
9. Dyslipidemia screening (PDF, 609 MB) for all children once between 9 and 11 years and once between 17 and 21 years, and for children at higher risk of lipid disorders
10. Fluoride supplements for children without fluoride in their water source
11. Fluoride varnish for all infants and children as soon as teeth are present
12. Gonorrhea preventive medication for the eyes of all newborns
13. Hearing screening for all newborns; and regular screenings (PDF, 609 KB) for children and adolescents as recommended by their provider
14. Height, weight and body mass index (BMI) measurements (PDF, 609 KB) taken regularly for all children
15. Hematocrit or hemoglobin screening for all children
16. Hemoglobinopathies or sickle cell screening for newborns
17. Hepatitis B screening for adolescents at higher risk
18. HIV screening for adolescents at higher risk
19. Hypothyroidism screening for newborns
20. PrEP (pre-exposure prophylaxis) HIV prevention medication for HIV-negative adolescents at high risk for getting HIV through sex or injection drug use
21. Immunizations for children from birth to age 18 — doses, recommended ages, and recommended populations vary:
    • Chickenpox (Varicella)
    • Diphtheria, tetanus, and pertussis (DTaP)
    • Haemophilus influenza type b
    • Hepatitis A
    • Hepatitis B
    • Human Papillomavirus (HPV)
    • Inactivated Poliovirus
    • Influenza (flu shot)
    • Measles
    • Meningococcal
    • Mumps
    • Pneumococcal
    • Rubella
    • Rotavirus
22. Lead screening for children at risk of exposure
23. Obesity screening and counseling
24. Oral health risk assessment (PDF, 609 KB) for young children from 6 months to 6 years
25. Phenylketonuria (PKU) screening for newborns
26. Sexually transmitted infection (STI) prevention counseling and screening for adolescents at higher risk
27. Tuberculin testing for children at higher risk of tuberculosis: Age 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years
28. Vision screening for all children
29. Well-baby and well-child visits

More information about preventive services for children

• Preventive services for children age 0 to 11 months
• Preventive services for children age 1 to 4 years
• Preventive services for children age 5 to 10 years
• Preventive services for children age 11 to 14 years
• Preventive services for children age 15 to 17 years