What This Means for You
- Most health insurance plans in Pennsylvania must cover key heart health screenings with no out-of-pocket cost when using in-network providers.
- Covered services typically include blood pressure, cholesterol, and diabetes screenings, as well as counseling for diet, exercise, and tobacco cessation.
- Consumers with questions about coverage or denied claims can contact the Pennsylvania Insurance Department at pa.gov/consumer or 1-866-PA-COMPLAINT.
HARRISBURG, PA — Pennsylvanians may be entitled to free preventive screenings and counseling to reduce their risk of heart disease, according to a reminder issued by the Pennsylvania Insurance Department during American Heart Month.
Heart disease remains one of the leading causes of death in the Commonwealth. State officials are encouraging residents to take advantage of preventive services that are required to be covered under most comprehensive health insurance plans.
What Is Covered Under the ACA?
Under the Affordable Care Act, commonly known as the ACA, most individual health insurance plans — purchased directly by consumers — and small group plans — typically offered by small employers — must cover certain preventive services without requiring copays, deductibles, or other out-of-pocket costs.
To qualify for full coverage, services must generally be provided by an in-network provider. An in-network provider is a doctor or health care facility that has a contract with a health insurer to provide services at negotiated rates.
According to the Insurance Department, commonly covered heart-related preventive services include:
- Blood pressure screenings
- Cholesterol screenings
- Diabetes screenings
- Obesity screenings and nutritional counseling
- Tobacco use screening and cessation counseling
- Routine wellness visits and annual checkups
- Counseling on healthy diet and physical activity for adults at risk of heart disease
These services are also covered through plans offered on Pennie, Pennsylvania’s official health insurance marketplace.
Oversight of Insurance Plans
The Pennsylvania Insurance Department reviews health insurance policy forms and premium rates before they are sold in the state. The department evaluates whether rates are excessive, inadequate, or unfairly discriminatory and monitors benefits to ensure compliance with federal and state law.
Officials said the goal is to ensure that consumers receive the preventive benefits required under the law.
What Consumers Should Do
The department recommends that residents review their policy documents, confirm that providers are in-network before scheduling appointments, and speak with their health care providers about heart health risks.
Consumers with questions about their insurance coverage, health plan benefits, or a denied claim can visit pa.gov/consumer or call 1-866-722-6675.
State officials said early detection and routine preventive care are key tools in reducing heart disease and related health complications across Pennsylvania.
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