What is Preventive During Pregnancy?
Under ACA guidelines, the following are considered preventive during pregnancy:
Initial Prenatal Visit with history and physical
Routine Prenatal Labs
Complete Blood Count (CBC): screens from anemia and infection
Blood Type and Rh Factor: checks for Rh incompatibility
Antibody Screen: looks for atypical antibodies
Rubella Immunity: determines immunity to German measles
Hepatitis B Surface Antigens (HBsAg): screens for Hepatitis B
HIV Testing: required in most states; opt-out in some
Syphilis test (RPR or VDLR): mandatory in many jurisdictions
Varicella (chickenpox) Immunity: sometimes included if unknown status
Urinalysis and Urine Culture: checks for urinary tract infection or other issues
Chlamydia and Gonorrhea Testing: especially if under age 25 or at risk
Pap Smear (if due): cervical cancer screening
Thyroid Function Test (TSH): if indicated or history present
Gestational Diabetes Screening (24–28 weeks)
Rh Antibody Testing
Screenings for Anemia, STIs, and UTIs
Tobacco Counseling, Alcohol/Drug Use Screening
Depression Screening
Lead Screening
Breastfeeding Support & Equipment (e.g., pump)
Follow up Routine Post-partum Visit at 6 weeks
The above are considered preventive because they’re aimed at early detections and risk mitigation, NOT diagnosing/treating the issue.
What is NOT Considered Preventive?
Below are examples of diagnostic or treatment-based procedures that are typically subject to member cost-sharing unless otherwise stated by the plan:
Ultrasounds: unless billed as screening (most plans cover one preventive, others are diagnostic)
High-risk OB care: gestational diabetes, preeclampsia, preterm labor, etc.
Labor and Delivery: including hospital stay and anesthesia
Non-routine Labs or Imaging: additional glucose testing, fetal echocardiograms, etc.
Postpartum Complications
Medications or Injections (e.g., Rhogam, Progesterone): unless preventive per formulary
Genetic Testing: often dependent on risk factors or plan policy