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Special Edition - EPRExpand Special Edition - EPR

 The Affordable Care Act and Prevention Benefits for Adolescents

By Atyya Chaudhry, MPP
Policy Analyst, Health Reform Implementation, AMCHP Atyya Chaudhry.jpg

In the United States, there are approximately 42 million adolescents (ages 10-19), making up about 14 percent of the population. While adolescence is generally a time of good health, access to appropriate preventive health care services is important to set adolescents on a path of optimal health through adulthood. With the passage of the Affordable Care Act (ACA) there have come many reforms to health insurance coverage and benefits for all populations including adolescents, recognizing their unique needs. The ACA includes an important provision that expands access to preventive services including contraceptive coverage.

Preventive Services – What's in it for adolescents?
The ACA eliminates cost sharing (co-pays or coinsurance) in most health insurance plans for services recommended by the United States Preventive Services Task Force (USPSTF), immunizations recommended by the Centers for Disease Control and Prevention, and evidence-informed preventive care and screenings recommended in the comprehensive guidelines supported by the Health Resources and Services Administration (HRSA) (i.e., Bright Futures). The Bright Futures guidelines recommends annual adolescent well-visits starting at the age of 11. The adolescent well-visit can include immunizations and preventive services within physical and behavioral health. The following is a chart of preventive services that are covered through the ACA:  

Recommended Preventive Service:Recommended for (relative to adolescence):
Alcohol and drug use assessmentsAdolescents
Behavioral assessments10 to 17 years
Cervical dysplasia screeningSexually active females
Depression screeningAdolescents
Dyslipidemia screening for those at high risk10 to 17 years
Height, weight and body mass index (BMI) measurements10 to 17 years
HIV ScreeningAdolescents at high risk
Immunization vaccines Various ages, more info here
Medical history 10 to 17 years
Oral health risk assessment 10 years
Sexually transmitted infection (STI) prevention counseling and screening Adolescents at higher risk
Tuberculin testing for those at high risk of tuberculosis10 to 17 years
Blood pressure screeningAdolescents
Hematocrit and Hemoglobin screeningAdolescents

Source: Preventive care benefits for children, U.S. Dept. of Health and Human Services, https://www.healthcare.gov/preventive-care-children/  and American Academy of Pediatrics, https://www.aap.org/en-us/professional-resources/practice-support/Periodicity/Periodicity%20Schedule_FINAL.pdf

Contraceptive Coverage
In addition to the preventive services covered without cost sharing or co-payment, the ACA also expands access to contraception coverage at zero cost sharing under most insurance plans. Contraceptive methods approved by the Food and Drug Administration (FDA) must be covered without charging a co-payment or coinsurance. FDA-approved contraceptive methods include hormonal methods, barrier methods, implanted methods, emergency contraception, sterilization procedures, and patient education and counseling. There are some employers that are exempt from providing contraceptive coverage, find out more here.

In addition to covering contraceptive methods, the ACA included funding for several teen pregnancy prevention programs. This includes funding for the Personal Responsibility Education Program (PREP), Pregnancy Assistance Fund, and restored funding for the Title V Abstinence Education Block Grant. Through these funding opportunities, recipients can deliver a variety of pregnancy prevention programs, and increase access to health care and social services. 

Recognizing the importance of adolescent health and preventive services, the Title V Maternal and Child Health Services Block Grant included a National Performance Measure on the adolescent well visit – the percent of adolescents, ages 12 through 17, with a preventive medical visit in the past year. The ACA represents a significant opportunity to improve access to preventive health care for adolescents. As states proceed with implementing the ACA, state MCH programs and their partners can ensure that the health reform law is serving adolescents as intended by considering the following:

  • Are adolescents and their families or guardians of adolescents aware of the array of preventive services and benefits available to them with zero cost sharing through their health insurance? 
  • Are adolescents and their families or guardians aware of confidential health services?
  • Are preventive services available in a wide-range of settings that serve adolescents, such as school and community-based health centers, family planning clinics, and physician offices? It is especially important to ensure access to care for special populations of youth including youth in foster care, child welfare and the juvenile justice systems, homeless youth, low-income young adults with special health care needs, and pregnant or parenting teens.
  • Is there coordination among state-level public or private agencies that serve adolescents and their families (such as WIC, Title X, school-linked health centers, among others)?

For more information on the ACA, please visit The Affordable Care Act: A Working Guide for MCH Professionals.