Wednesday, July 29, 2015

The Affordable Care Act and families: What do I need to know?

Find out how the Affordable Care Act affects families and what preventative services are covered for children.

The Affordable Care Act and families: What do I need to know?


Whether you’ll be signing up for health insurance through the marketplace or your employer, there are things that families should know when it comes to health insurance and preventative services for children under the Affordable Care Act.

The American Academy of Pediatrics put together a useful list for families. Here are some of the main highlights: 

1. Benefits and protections are already available. 

Expanded Coverage:

  • Children under age 26 can be covered by a parent’s health insurance policy.
  • Youth under age 26 who aged out of foster care at age 18 or older will be eligible for Medicaid coverage effective January 1, 2014.
  • Children under age 19 can’t be denied coverage because of a pre-existing condition.


  • Families can choose a pediatrician as a child’s primary care doctor.
  • New private health plans must cover the cost of preventive care.
  • Out-of-pocket costs are capped at $5,950/individual/year and $11,900/family/year.


  • Insurance companies can no longer set lifetime dollar limits on health benefits.
  • Insurance companies can no longer drop people if they get sick.

2. The marketplace is a new way to get health insurance for you and your family.

You can buy insurance directly from an insurance company or through a broker, or you can sign up through your new state marketplace. Through the marketplace, you can also find out if you qualify for Medicaid or the Children’s Health Insurance Program (CHIP).

3. The marketplace offers a number of different health plans, and families should compare plans to ensure they meet their needs.

The marketplace offers 4 different levels of health insurance plans. Those least expensive (bronze) have fewer benefits and higher out-of-pocket costs. Those that are the most expensive (platinum) have more benefits and lower out-of-pocket costs. Make sure you choose an insurance plan that works for your family’s needs.

Families, especially those who have children with special health care needs, need to make sure the plan they purchase includes:

  • Access to pediatric specialists and pediatric surgical specialists.
  • Preventive care, such as well-child check-ups and immunizations.
  • Habilitative services to help a child keep, learn, or improve functioning.
  • Rehabilitative services such as physical or speech therapy.

In addition to information from the AAP, another useful resource is the list of  preventative care services for children covered by the ACA at All marketplace health plans and many other plans must cover the following list of preventive services for children without charging a copayment or coinsurance. This is true even if you haven’t met your yearly deductible.


  1. Autism screening for children at 18 and 24 months
  2. Behavioral assessments for children at the following ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years.
  3. Blood Pressure screening for children at the following ages: 0 to 11 months, 1 to 4 years , 5 to 10 years, 11 to 14 years, 15 to 17 years.
  4. Cervical Dysplasia screening for sexually active females
  5. Depression screening for adolescents
  6. Developmental screening for children under age 3
  7. Dyslipidemia screening for children at higher risk of lipid disorders at the following ages: 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years.
  8. Fluoride Chemoprevention supplements for children without fluoride in their water source
  9. Gonorrhea preventive medication for the eyes of all newborns
  10. Hearing screening for all newborns
  11. Height, Weight and Body Mass Index measurements for children at the following ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years.
  12. Hematocrit or Hemoglobin screening for children
  13. Hemoglobinopathies or sickle cell screening for newborns
  14. HIV screening for adolescents at higher risk
  15. Hypothyroidism screening for newborns
  16. Immunization vaccines for children from birth to age 18 —doses, recommended ages, and recommended populations vary:
  17. Iron supplements for children ages 6 to 12 months at risk for anemia
  18. Lead screening for children at risk of exposure
  19. Medical History for all children throughout development at the following ages: 0 to 11 months, 1 to 4 years , 5 to 10 years , 11 to 14 years , 15 to 17 years.
  20. Obesity screening and counseling
  21. Oral Health risk assessment for young children Ages: 0 to 11 months, 1 to 4 years, 5 to 10 years.
  22. Phenylketonuria (PKU) screening for this genetic disorder in newborns
  23. Sexually Transmitted Infection (STI) prevention counseling and screening for adolescents at higher risk.
  24. Tuberculin testing for children at higher risk of tuberculosis at the following ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years.
  25. Vision screening for all children.


Do you have any questions? Need some help? Each state’s marketplace has people who can help you compare plans and enroll your family in coverage, or call 1-800-318-2596 (available 24/7).

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About this blog
The Healthy Kids blog is your window into the latest news, research and advice around children's health. Learn more about our growing list of contributors here.

If you have questions about your child's health, ask them here.

Anna Nguyen Healthy Kids blog Editor
Sarah Levin Allen, Ph.D., CBIS Assistant Professor of Psychology at Philadelphia College of Osteopathic Medicine
Stephen Aronoff, M.D., M.B.A. Chair of the Department of Pediatrics at Temple University Hospital
Peter Bidey, D.O. Medical Director of Family Medicine at Philadelphia College of Osteopathic Medicine
Christopher C. Chang, MD, PhD, MBA, FAAAAI, FACAAI Associate Professor of Medicine in division of Rheumatology, Allergy and Clinical Immunology at UC Davis
Katherine K. Dahlsgaard, Ph.D. Lead Psychologist of The Anxiety Behaviors Clinic at Children's Hospital of Philadelphia
Gary A. Emmett, M.D., F.A.A.P Director of Hospital Pediatrics at TJU Hospital & Pediatrics Professor at Thomas Jefferson Univ.
Magee DeFelice, M.D. Division Chief of Allergy and Immunology at Nemours/Alfred I. duPont Hospital for Children
Hazel Guinto-Ocampo, M.D. Chief of Pediatric Emergency Services at Nemours duPont Pediatrics/Bryn Mawr Hospital
Rima Himelstein, M.D. Adolescent Medicine Specialist at Crozer-Keystone Health System
Jessica Kendorski, PhD, NCSP, BCBA-D Associate Professor in School Psychology/Applied Behavior Analysis at Philadelphia College of Osteopathic Medicine
Anita Kulick President & CEO, Educating Communities for Parenting
Janet Rosenzweig, MS, PhD, MPA VP for Programs & Research for Prevent Child Abuse America
Beth Wallace Smith, R.D. Registered Dietitian at Children's Hospital of Philadelphia
Emiliano Tatar, M.D. Pediatrician at Einstein Healthcare Network Roxborough Plaza
Jeanette Trella, Pharm.D Managing Director at The Poison Control Center at CHOP
W. Douglas Tynan, Ph.D., ABPP Director of Integrated Health Care for American Psychological Association
Flaura Koplin Winston, M.D., Ph.D. Scientific Director of the Children’s Hospital of Philadelphia’s Center for Injury Research and Prevention
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