Insurance Coverage for Preventive Health Services

Most 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 healthcare 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 2018, 61.8 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.2 If your teen has private insurance, contact the healthcare provider or health insurance company to learn the specifics. An additional 35.7 percent of people under age 19 had public health insurance at some point during 2018.2 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 Healthcare

Although clinical preventive services are vital to adolescent health, teens are less likely than younger children and adults to receive recommended preventive health services. In 2014, more than one in five (21 percent) adolescents ages 10-17 did not have well-child check-up and 12 percent did not have a dental visit in the past 12 months.3 In addition, Hispanic (versus non-Hispanic white) adolescents, low-income adolescents*, and uninsured (versus covered by private or public health insurance) adolescents were more likely to not have a usual place for preventive care.3 Another study found that less than half of teens received any health education and counseling during their preventive health visit, and 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.4

* Low-income adolescents are adolescents with family income less than or equal to 138% of the federal poverty level (FPL)

Footnotes

1 U.S. Department of Health & Human Services. (2016). The Affordable Care Act: Preventive Care. Retrieved from https://www.hhs.gov/healthcare/about-the-aca/preventive-care/index.htmlback to top

2 Berchick, E.R., Barnett, J.C. & Upton, R.D. (2019). Health Insurance Coverage in the United States: 2018. Washington, DC: U.S. Government Printing Office. Retrieved from https://www.census.gov/content/dam/Census/library/publications/2019/demo/p60-267.pdfback to top

3 Black, L. I., Nugent, C. N., & Vahratian, A. (2016). Access and utilization of selected preventive health services among adolescents aged 10-17. NCHS data brief, no. 246. Hyattsville, MD: National Center for Health Statistics. Retrieved from https://www.cdc.gov/nchs/products/databriefs/db246.htmback to top

4 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 from https://www.ncbi.nlm.nih.gov/pubmed/19336348. back to top