Find out what health insurance is changing about preventative coverage in Madison, Wisconsin.

What is Health Insurance Changing About Preventative Care Coverage in WI?

With a new health care focus on preventing future health issues, health insurance companies are providing more coverage for preventative care.  What does this change in health insurance mean for families and individuals? The new health care law (the Affordable Care Act) may enable Wisconsin residents to get access to certain preventative services with no out-of-pocket costs instead of simply treating health issues when they occur.


Under the Affordable Care Act (ACA), all ACA-compliant plans cover preventative care. Some preventative services are covered at $0 copay even if you haven’t met your deductible. 

 

Preventative Care Services Health Insurers in WI are Generally Required to Cover

Children

  • Alcohol misuse screening and counseling
  • Autism screening at 18 and 24 months (treatment for autism spectrum disorders required in Wisconsin)
  • Behavioral assessments at periods up to 17 years
  • Blood pressure screening at periods up to 17 years
  • Cervical dysplasia screening for sexually active females
  • Depression screening for adolescents
  • Developmental screening for children under ​three years old
  • Dyslipidemia screening for children at higher risk of lipid disorders periodically up to age 17
  • Fluoride chemo-prevention supplements for children without water fluoride
  • Gonorrhea preventive medication for the eyes of all newborns
  • Range of screenings for newborns that include hearing and vision 
  • Height, weight and body mass index measurements periodically up to age 17
  • Hematocrit or hemoglobin screening
  • HIV screening from age 15 and older; sexually transmitted infection prevention counseling for adolescents at higher risk
  • Immunization vaccines
  • Lead screening for children at risk
  • Periodic medical history
  • Periodic oral, vision and hearing screening. Hearing aids, cochlear implants and related treatment for infants and children required by Wisconsin 
  • Periodic TB testing

Women

  • Breast ​cancer ​genetic test counseling for women at higher risk for breast cancer
  • Mammograms every one or two years for women over 40 (breast reconstruction is covered in Wisconsin if the policy covers mastectomy)
  • Breast cancer chemo / prevention counseling for women at higher risk
  • Cervical cancer screening for sexually active women
  • Chlamydia infection screening
  • Contraception, except for plans provided by “religious employers”
  • Domestic and interpersonal violence screening and counseling
  • HPV DNA test every ​three years for those with normal cytology results who are 30 or older
  • Osteoporosis screening for those over 60, depending on risk factors
  • Well woman visits to get recommended services for women under 65 

Pre / Pregnant / Postpartum Women

  • Anemia screening for pregnant women
  • Breast feeding comprehensive support and counseling
  • Folic acid supplements for women who may become pregnant
  • Gestational diabetes screening for women 24 to 28 weeks pregnant ​and pregnant women at high risk 
  • Hepatitis B screening for pregnant women at the first prenatal visit
  • RH Incompatibility screening for all pregnant women
  • Urinary tract or other infection screening for pregnant women

All Adults

  • Alcohol misuse screening and counseling
  • Abdominal aortic aneurysm one-time screening for men 
  • Aspirin use to prevent cardiovascular diseases
  • Blood pressure screening
  • Cholesterol screening for adults over 50
  • Colonoscopy for adults of certain ages and risk factors (required by Wisconsin)
  • Depression screening
  • Diabetes (Type 2) screening for adults ​with high blood pressure
  • Diet counseling for adults at higher risk for chronic disease
  • HIV screening adults up to age 65
  • Immunization vaccines
  • Obesity screening
  • Sexually transmitted infection prevention counseling for adults at higher risk
  • Tobacco use screening
  • Temporoamadibular disorder diagnostic & treatment procedures (Wisconsin)

This list is not comprehensive. Individuals with specific health conditions may have additional screening coverage and preventative care covered by their plans.


All of Unity’s plans offer the preventative services listed above with zero out-of-pocket costs as well as other essential health benefits. Browse Unity's health insurance plans in Wisconsin and get a quote today!


 




  1. https://www.healthcare.gov/fees-exemptions/fees-exemptions-overview/