Table 1.
Services covered by the Affordable Care Act, by guideline source
| Measure | USPSTF <18 | USPSTF ≥18 | Bright futures | HRSA Women’s Guidelines |
|---|---|---|---|---|
| Nutrition/exercise/obesity | ||||
| Obesity/body mass index | ✓>6 y | ✓All adults | ✓ | ✓All adults and children |
| Hypertension/blood pressure | — | ✓≥18 y | ✓ | “Covered in child well visit” |
| Lipid disorder | — | ✓≥20 y and risk factors | ✓In late adolescence | ✓Children and adults with risk factors |
| Healthy diet | — | ✓Adults with risk factors | ✓ | ✓Adults with risk factors |
| Routine counseling for physical activity | — | — | ✓ | — |
| Substance use | ||||
| Tobacco use | ✓School-aged children and adolescents | ✓Adults, including pregnant women who use tobacco >18 | After risk assessment | ✓All adults and cessation interventions for tobacco users |
| Alcohol use | NR | ✓All adults | After risk assessment | ✓Adults and adolescents |
| Mental health | ||||
| Suicide screening | NR | NR | ✓ | — |
| Screening for depression | ✓12–18 y, screening for major depressive disorder should be implemented with adequate systems in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up. | ✓Adults, including pregnant and postpartum women. Screening should be implemented with adequate systems in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up. | ✓ | ✓Adults and adolescents |
| Other illicit drug use (screening and counseling) | NR | NR | After risk assessment | — |
| Safety/violence | ||||
| Family/partner violence | ✓Women of childbearing age | ✓Women of childbearing age | ✓ | ✓All women |
| Fighting | — | — | ✓ | — |
| Helmets | — | — | ✓ | — |
| Seat belts | — | — | ✓ | — |
| Guns | — | — | ✓ | — |
| Bullying | — | — | ✓ | — |
| Reproductive health | ||||
| STI screening | ✓Sexually active adolescents and adults at increased risk | ✓Sexually active adolescents and adults at increased risk | ✓If sexually active | ✓Adults and adolescents with risk factors |
| STI counseling | ✓Sexually active adolescents and adults at increased risk | ✓Sexually active adolescents and adults at increased risk | ✓If sexually active | ✓Adults and adolescents with risk factors |
| Cervical cancer screening | — | ✓≥21, every 3 years | ✓If sexually active within 3 years of onset of sexual activity or no later than age 21 | ✓Sexually active women |
| Chlamydia screening (female) | ✓Sexually active ≤24 y | ✓Sexually active ≤24 y | ✓If sexually active | ✓Younger women and other women with risk factors |
| Chlamydia screening (male) | NR | NR | Screen in sexually active adolescents | — |
| Gonorrhea screening | ✓Sexually active ≤24 y | ✓Sexually active ≤24 y | ✓If sexually active | ✓Women at increased risk |
| HIV screening | ✓Adolescents and adults (16–65 y) at increased risk for HIV infection | ✓Adolescents and adults (16–65 y) at increased risk for HIV infection | ✓If sexually active and + on risk assessment | ✓Anyone 15 to 65 y at least once |
| Syphilis screening | ✓All persons at increased risk for syphilis infection | ✓All persons at increased risk for syphilis infection | ✓If sexually active and + on risk assessment | ✓Women at increased risk |
| Pregnancy | — | — | ✓Sexually active females w/o contraception, late menses, amenorrhea, or heavy or irregular bleeding | — |
| Birth control methods | — | — | ✓ | Most insurance plans must cover birth control that is prescribed by a woman’s doctor |
| Screening | ||||
| Testicular cancer | Recommended against | Recommended against | ✓In late adolescence | — |
| Anemia test | — | — | After risk assessment | ✓Routinely for pregnant women |
| Tuberculosis test | Update in progress | Update in progress | After risk assessment | ✓Children at high risk of tuberculosis |
| Hearing test: audiometry | — | — | After risk assessment | — |
| Vision test: Snellen test | — | — | ✓ln each stage of adolescence | ✓Children of all ages |
|
| ||||
| Immunizations As Recommended By the CDC | 11–12 | 13–18 | 19–26 | |
|
| ||||
| Tetanus, diphtheria, pertussis (Tdap/TD) | * | Catch up | Substitute one-time dose of Tdap for Td booster; then boost with Td every 10 y | |
| Human papillomavirus | *** | Catch up | ***For males if risk factor present or as catch up. ***For females as catch up only | |
| MCV4 (Meningococcal) | * | Booster at age 16 or catch up | *Or more if risk factor is present | |
| HepB (Hepatitis B) | Catch up | Catch up | ***If risk factor is present | |
| Polio | Catch up | Catch up | ***If at increased risk of exposure to poliovirus or who have never been vaccinated against polio | |
| MMR (measles, mumps, rubella) | Catch up | Catch up | * Or **doses if risk factor present or as catch up | |
| Varicella (chickenpox) | Catch up | Catch up | **If risk factor is present | |
| Hepatitis A | Catch up For those meeting CDC’s risk criteria |
Catch up For those meeting CDC’s risk criteria |
**If risk factor is present | |
| Pneumococcal (polysaccharide) | For those meeting CDC’s risk criteria | For those meeting CDC’s risk criteria | For those meeting CDC’s risk criteria | |
| Influenza | Recommended annually | Recommended annually | Recommended annually | |
*, **, *** denote number of doses.
NR = insufficient evidence to recommend for or against; Recommend Against = recommend against; USPSTF = U.S. Preventive Services Task Force; y = years; ✓ = a recommendation; – = No mention of recommendation.
Adapted from Centers for Disease Control and Prevention. 2015 Recommended Immunizations for Children from 7 through 18 years old. http://www.cdc.gov/vaccines/who/teens/downloads/parent-version-schedule-7-18yrs.pdf.