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Insurance Coverage for Preventive Health Services

Health plans are required to cover recommended preventive services for children and for older adolescents and young adults at no cost to patients when delivered by a health care provider in their health plan’s network.1 The specifics may differ depending on whether adolescents and young adults have public or private insurance. In 2015, 62.6 percent of people under age 19 were covered at some point during the year by private insurance, which offers a range of preventive health screening and counseling services. If your teen has private insurance, ask the health care provider or contact the health insurance company to learn the specifics. An additional 42.6 percent of children had public health insurance at some point during 2015.2 Coverage under one common type of public insurance, Medicaid, differs by state. Learn more about what Medicaid covers in your state. If a teen does not have a primary care provider, visiting a local federally qualified health center is a good place to start. Find a federally qualified health center near you.

Many Adolescents Do Not Receive Preventive Health Care

Although clinical preventive services are vital to adolescent health, many adolescents do not receive all the preventive care that they need. For example, almost one in three 11- to 21-year-olds who visited the doctor’s office during 2004–2010 were not screened for tobacco use (or the doctor did not document whether or not they use tobacco), and 80 percent of those who screened positive for tobacco use didn’t receive assistance to stop use, such as tobacco counseling.3 In addition, low-income and uninsured adolescents are less likely to receive preventive health care than their higher income or insured peers.4

Counseling on making healthy choices and minimizing risky behaviors is important preventive care that few teens receive. One study found that less than half of teens received any health education and counseling during their preventive health visit.5 Teens were more likely to receive a basic screening (e.g., measuring height and weight) than comprehensive screenings and counseling, such as discussions of healthy eating, exercise habits, and substance use.6



Footnotes


1 U.S. Department of Health & Human Services. (2016). The Affordable Care Act: About the Law. Retrieved January 26, 2017, from https://www.hhs.gov/healthcare/about-the-law/index.html
2 Barnett, J.C. & Vornovitsky, M.S. (2016.) Current Population Reports: Health Insurance Coverage in the United States, 2015. Washington, DC: U.S. Department of Commerce. Retrieved November 18, 2016, from https://www.census.gov/content/dam/Census/library/publications/2016/demo/p60-257.pdf
3 Centers for Disease Control and Prevention. (2014.) Use of Selected Clinical Preventive Services to Improve the Health of Infants, Children, and Adolescents — United States, 1999–2011. Morbidity and Mortality Weekly Report,63(Suppl-2). Retrieved November 22, 2016, from http://www.cdc.gov/mmwr/pdf/other/su6302.pdf
4 Adams, S.H., Park, J., & Irwin, C.E. Jr. (2015.) Adolescent and Young Adult Preventive Care. Comparing National Survey Rates. American Journal of Preventive Medicine, 49(2): 238-247. Retrieved November 18, 2016, from https://www.ncbi.nlm.nih.gov/pubmed/25935503
5 Irwin, C.E. Jr., Adams, S.H., Park, M.J., and Newacheck, P.W. (2009). Preventive care for adolescents: few get visits and fewer get services. Pediatrics, 123(4): e565-72. Retrieved November 18, 2016, from https://www.ncbi.nlm.nih.gov/pubmed/19336348
6 Irwin, C.E. Jr., Adams, S.H., Park, M.J., and Newacheck, P.W. (2009). Preventive care for adolescents: few get visits and fewer get services. Pediatrics, 123(4): e565-72. Retrieved November 18, 2016, from https://www.ncbi.nlm.nih.gov/pubmed/19336348
Content created by Office of Adolescent Health
Content last reviewed on March 16, 2017