Covered Preventative Care Services

Under the Affordable Care Act (ACA), Yale Health is required to cover certain preventive health services at no cost to members. This means these services must be provided without member cost-sharing—no copayments, coinsurance, or deductibles—when received from an in-network provider.

This requirement is based on the principle that preventive care improves health outcomes and reduces long-term health costs by detecting conditions early or preventing illness altogether.

Legal & Clinical Basis for Coverage

We are required to cover preventive services that receive:

An “A” or “B” rating from the U.S. Preventive Services Task Force (USPSTF),
Immunizations recommended by the Advisory Committee on Immunization Practices (ACIP),
Preventive care and screenings for infants, children, and adolescents as per the Health Resources and Services Administration (HRSA) Bright Futures guidelines,
Preventive care and screenings for women, including pregnant and postpartum individuals, as specified by HRSA-supported Women’s Preventive Services Initiative (WPSI).

These requirements apply under Section 2713 of the Public Health Service Act, enacted through the ACA.

Below is a comprehensive list of preventive services covered with no cost-sharing, divided into three categories:

Adults: (Ages 18 and Older) - Preventive services for adults must be provided by in-network providers and are generally annual unless otherwise indicated.
Women: (Including Pregnant & Postpartum); women are eligible for HRSA-supported services, provided in-network and in accordance with screening intervals.
Children and Adolescents: Pediatric preventive care follows the Bright Futures guidelines and includes age-appropriate services at specified intervals.

Preventative Services Covered at No Cost
ADULTS
Preventative Service	Clinical Indication	In-Network Location
Abdominal Aortic Aneurysm one-time screening	Men between 65 to 75 years who have ever smoked	Yale Health Diagnostic Imaging
Alcohol Misuse Screening & Counseling	For all adults	Yale Health Center
Aspirin Use	For adults 50 to 59 years with a high cardiovascular risk; prevent cardiovascular disease and colorectal cancer	Yale Health Pharmacy
Blood Pressure Screening	For adults aged 18+, at every healthcare visit or as recommended	Yale Health Center
Cholesterol Screening	Men age 35+ and women age 45+ Younger adults with increased cardiovascular risk	Any Quest Lab in New England (CT, ME, MA, NH, RI, and VT)
Colorectal Cancer Screen	Adults aged 45 to 75 Methods include stool tests, colonoscopy, and others as approved.	Any Quest Lab in New England (CT, ME, MA, NH, RI, and VT)
Depression Screening	All adults, with appropriate follow-up	Yale Health Center/Magellan BH
Diabetes Screening	Adults aged 40 –70 who are overweight or obese	Yale Health Center
Diet Counseling	For adults at higher risk for chronic disease	Yale Health Center
Falls Prevention	For adults 65 years and over, living in a community setting; with exercise or physical therapy and vitamin D use	PTSMC
Hepatitis B Screening	For people at high risk, including people from countries with 2% or more Hepatitis B prevalence, and U.S.-born people not vaccinated as infants and with at least one parent born in a region with 8% or more Hepatitis B prevalence.	Any Quest Lab in New England (CT, ME, MA, NH, RI, and VT)
Hepatitis C Screening	For adults aged 18 to 79 years	Any Quest Lab in New England (CT, ME, MA, NH, RI, and VT)
HIV Screening	For everyone age 15 to 65, and other ages at increased risk	Any Quest Lab in New England (CT, ME, MA, NH, RI, and VT)
Immunizations	For adults — doses, recommended ages, and recommended populations vary: Chickenpox (Varicella) COVID-19 Diphtheria Flu (influenza) - annually Hepatitis A Hepatitis B Human Papillomavirus (HPV) (up to age 45, if not previously vaccinated) Measles Meningococcal Mumps Whooping Cough (Pertussis) Pneumococcal (age 65+ or at-risk adults) Rubella Shingles (age 50+) Tetanus	Yale Health Center
Lung Cancer Screening	Annual low-dose CT scans for adults aged 50–80 with a history of heavy smoking or have quit in the past 15 year	Yale Health Diagnostic Imaging
Obesity Screening & Counseling	Includes behavioral interventions for weight loss.	Yale Health Center
PrEP (pre-exposure prophylaxis) HIV prevention medication	For HIV-negative adults at high risk for getting HIV through sex or injection drug use	Yale Health Pharmacy
Sexually Transmitted Infections (STIs) Screening	Includes syphilis, HIV, gonorrhea, and chlamydia for at-risk individuals.	Any Quest Lab in New England (CT, ME, MA, NH, RI, and VT)
Statin Preventive Medication	For adults 40 to 75 at high risk	Yale Health Pharmacy
Tobacco Use Screening & Cessation Counseling	For all adults and cessation interventions for tobacco users; including counseling and medications	Yale Health Center
Tuberculosis Screening	For certain adults without symptoms at high risk	Any Quest Lab in New England (CT, ME, MA, NH, RI, and VT) / Yale Health Diagnostic Imaging

Preventative Services Covered at No Cost
WOMEN
Preventative Service	Clinical Indication	In-Network Location
Bone Density Screening	For all women over age 65 or women aged 64 and younger that have gone through menopause	Yale Health Diagnostic Imaging
Breast Cancer Risk Assessment (BRCA) & Genetic Counseling Testing	For women with family history of breast, ovarian, tubal, or peritoneal cancer	Yale Health / Specialist / Lab
Breast Cancer Chemoprevention Counseling	For at-risk women	Yale Health / Specialist
Breast Cancer Screening (Mammograms)	Mammography every 1–2 years for women aged 40+; with or without clinical breast examination; excludes 3D imaging needed for dense breast.	YNHH Mammography Van; Various YNHH Locations
Breast Feeding Support, Supplies and Counseling	During pregnancy and postpartum	Yale Health Center
Cervical Cancer Screening (Pap Smear and/or HPV Test)	Pap smear every 3 years (ages 21–65) OR Co-testing (HPV + Pap) every 5 years (ages 30–65)	Yale Health Center
Chlamydia Infection Screening	For younger women and other women at higher risk	Yale Health Center
Contraceptive Services	Includes all FDA-approved methods, sterilization procedures, and patient education.	Yale Health Pharmacy
Diabetes Screening	For women with a history of gestational diabetes who aren’t currently pregnant and who haven’t been diagnosed with type 2 diabetes before	Yale Health Center
Expanded Tobacco Intervention and Counseling	For pregnant tobacco users	Yale Health Center
Folic Acid	Supplements for women who may become pregnant.	Yale Health Pharmacy
Gestational Diabetes Screening	Between 24 weeks pregnant (or later and those at high risk of developing gestational diabetes	Yale Health Center
Gonorrhea Screening	For all women at higher risk	Any Quest Lab in New England (CT, ME, MA, NH, RI, and VT)
Hepatitis B Screening	For pregnant women at their first prenatal visit	Any Quest Lab in New England (CT, ME, MA, NH, RI, and VT)
HIV Screening	For everyone age 15 to 65, and other ages at increased risk	Any Quest Lab in New England (CT, ME, MA, NH, RI, and VT)
Intimate Partner Violence Screening	For all women	Yale Health Center/Magellan BH
Maternal Depression Screening for Mothers at Well-Baby Visits	For all mothers	Yale Health Center
Preeclampsia Prevention (Aspirin) and Screening	For pregnant women with high blood pressure	Yale Health Center
PrEP (pre-exposure prophylaxis) HIV prevention medication	For HIV-negative women at high risk for getting HIV through sex or injection drug use	Yale Heath Pharmacy
Rh Incompatibility Screening	For all pregnant women and follow-up testing for women at higher risk	Any Quest Lab in New England (CT, ME, MA, NH, RI, and VT)
Sexually Transmitted Infections Counseling	For sexually active women	Yale Health Center
Syphilis Screening	For at-risk women	Yale Health Center
Tobacco Use Screening and Interventions	For all adults and cessation interventions for tobacco users; including counseling and medications	Yale Health Center
Urinary Incontinence Screening	For all women	Yale Health Center
Well-Woman Visits	To get recommended services for all women	Yale Health Center

Preventative Services Covered at No Cost
Children and Adolescents
Preventative Service	Clinical Indication	In-Network Location
Alcohol, Tobacco, and Drug Use Assessment	For adolescents	Yale Health Center
Autism Screening	For children at 18 and 24 months	Magellan BH
Behavioral Assessments	For children at all well-child visits	Yale Health Center/Magellan BH
Bilirubin Concentration Screening	For newborns	Any Quest Lab in New England (CT, ME, MA, NH, RI, and VT)
Blood Pressure Screening	For newborns and children	Yale Health Center
Cervical Dysplasia Screening	For sexually active females	Yale Health Center
Cholesterol Screening	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	Any Quest Lab in New England (CT, ME, MA, NH, RI, and VT)
Depression Screening	For adolescents beginning routinely at age 12	Yale Health Center/Magellan BH
Developmental Screening (9, 18, and 30 months)	For children under age 3	Yale Health Center
Fluoride Supplements	For children without fluoride in their water source	Yale Health Pharmacy
Gonorrhea Preventive Medication	For the eyes of all newborns	Yale Health Pharmacy
Hearing Screening	For all newborns; and regular screenings for children and adolescents as recommended by their provider	Yale Health Center
Height, Weight and Body Mass Index (BMI) Measurements	Taken regularly for all children	Yale Health Center
Hematocrit or Hemoglobin Screening	For all children	Any Quest Lab in New England (CT, ME, MA, NH, RI, and VT)
Hematologic Screening for Sickle Cell and Other Disorders	For newborns	Yale Health Center / Any Quest Lab in New England (CT, ME, MA, NH, RI, and VT)
Hepatitis B Screening	For adolescents at risk	Any Quest Lab in New England (CT, ME, MA, NH, RI, and VT)
Iron Supplements	For at-risk infants	Yale Health Pharmacy
Lead Screening (12 and 24 months, or based on risk)	For children at risk of exposure	Any Quest Lab in New England (CT, ME, MA, NH, RI, and VT)
Newborn Screening (metabolic, hearing, congenital heart)	For newborns	Yale Health Center
Obesity Screening & Nutritional Counseling	For children at risk	Yale Health Center
Phenylketonuria (PKU) Screening	For newborns	Any Quest Lab in New England (CT, ME, MA, NH, RI, and VT)
Sexually Transmitted Infections (STI) Counseling & Testing	For adolescents at higher risk	Yale Health Center
Tuberculin Testing	For children at higher risk of tuberculosis	Any Quest Lab in New England (CT, ME, MA, NH, RI, and VT)
Vision Screening	For all children	Yale Health Center
Well-Baby and Well-Child Visits	To get recommended services for all babies and children	Yale Health Center

Coverage Parameters and Considerations

In-Network Only: Preventive services must be provided by in-network providers to qualify for zero cost-sharing.
Not Diagnostic: Services must be preventive in nature. If a service is performed to diagnose, monitor, or treat a known condition, it may not qualify as zero-cost.
Age/Interval Requirements: Coverage is based on age, gender, and risk factors. Frequency may vary based on USPSTF and Bright Futures guidance.
Clinical Judgment Applies: Providers may recommend services more frequently than outlined. Additional services beyond guideline-recommended intervals may not be covered without cost-sharing.

Key Takeaways

Zero-Cost Preventive Services are a cornerstone of ACA-compliant plans.
These services are evidence-based, focused on prevention, and structured by national public health authorities.
Members are encouraged to engage in annual preventive care to stay healthy and catch issues early—at no additional cost.