Well-Child Visits: What Health Reform Covers

Medically Reviewed by Sarah Goodell on September 04, 2024

• Well-Child Visits
• Well-Child Checkups: Birth to Age 2
• Well-Child Checkups: Age 2 to 18
• Other Child Health Benefits

Your children need regular preventive care from a doctor, sometimes called wellness visits or well-child visits. These checkups may include blood tests, height and weight measurements, and vaccines and will help track and protect your child’s health as they grow into an adult.

The Affordable Care Act uses guidelines set by the American Academy of Pediatrics and the US Preventive Services Task Force as the blueprint for providing children's health care. Those guidelines call for:

• Regular checkups from birth through age 18
• Scheduled immunizations
• Screenings for childhood diseases

You do not have to pay a copay for this care because it is preventive care and is covered under most, but not all, insurance plans (see exceptions below).

Well-Child Visits

Your children will do best if you make sure they get well-child visits on a regular basis. This should start even before they're born. As a mom-to-be, you are entitled to prenatal visits. That gives you a chance to talk to a doctor about breastfeeding, child safety, and newborn care.

Well-child visits should follow this schedule:

• Right after your baby is born
• At 1 week old
• At 1 month old
• At 2 months old
• At 4 months old
• Every three months from 6 months old to 18 months old
• At 2 years old and 2 1/2 years old
• Every year from 3 years old until age 18

These visits for preventive care can be separate from other appointments.

Well-Child Checkups: Birth to Age 2

At every checkup, your child's doctor will look mostly for the same things:

• Your baby's growth by measuring their head, weight, and height
• Your baby's nourishment by talking about your baby's eating habits
• Your baby's physical development and movement
• Your baby's language development by listening to the sounds they make and how they echo sounds
• Your baby's socialization by talking with you about how they respond to you and to other people they come in contact with
• Your baby's safety at home, away from home, and in the car
• Needed immunizations

The nature of the exams will change somewhat depending on your baby's age.

Your child's doctor may do some specific screening tests or offer some preventive measures at specific well-child visits. Examples include:

• Fluoridesupplements. If you live somewhere without fluoride in your water source, your pediatrician will prescribe fluoride supplements for your child starting at age 6 months at no cost to you.
• AutismSpectrum Disorder (ASD) screening. At almost every visit, the doctor looks for signs of ASD based on what you say about your baby as well as by observing your child. A more formal test for autism happens twice -- at 18 months and at 24 months. At these times, your doctor will ask you to fill out a questionnaire about your baby's behavior and development.
• Lead screening. If you live in a house that was built before 1978, your pediatrician will test a small sample of your child's blood at 9-12 months and at 24 months to check the amount of lead in it.

Well-Child Checkups: Age 2 to 18

Your child's doctor checks the same general things at every checkup, but there are specific details they look at depending on your child's age.

• Growth andnutrition: Weight, height, BMI, and blood pressure checks start at age 3, and cholesterol screenings are done between the ages of 9 and 11 and at age 17.
• Development: The doctor will inquire about your child's speech, coordination, strength, playing habits, learning, physical activity, behavior in school, sleep habits, and other things.
• Oral Health: Checkups include an examination of your child's mouth and teeth to check their risk of getting cavities. If needed, your child will be referred to a pediatric dentist for treatment.
• Vision: Screening happens at every wellness visit. Your child will get a more complete eye exam around age 3 or 4.
• Hearing: Screening recommendations vary, so ask your doctor if there will be an additional charge for a hearing test at age 4 or 5.
• Vaccines: The type and timing can vary, so talk with your doctor.
• Safety counseling: The doctor will provide counseling on such things as safety at home, away from home, and in the car. For younger children, this can involve preventing poisoning and talking to strangers. By school age, your child's doctor will talk about bullying and screen time. Teenagers talk with their doctors about their home life, extracurricular activities, alcohol use, drug use, sex and STD prevention, and technology safety. The doctor may also ask about the presence of guns in the house and whether they are kept in a safe place.

Other Child Health Benefits

You and your child also have other benefits under health care reform:

• Your children must be covered by your health plan if you choose to include them, although you will likely have to pay more than you do if your plan only covers yourself. Insurers must enroll your child even if they have a pre-existing condition.
• The amount of money you pay out-of-pocket for medical care andprescriptionsis capped. This means there is a maximum amount you'll have to pay for the care you receive from doctors and hospitals that participate in your health plan. You'll have less financial worry stemming from paying to treat a child with a serious illness.
• Your children's care will not have an annual or lifetime maximum. That's because health reform did away with yearly and lifetime limits for insurance coverage. This means that children with a chronic illness can get care as long as it is needed.
• Your children will get essential health benefits. All plans sold through state Marketplaces, directly to individuals, or through small employers must cover certain items and services, including doctor's office visits, prescription medications, screenings, and vaccines, services to help with injuries or disabilities, and child dental and vision care. Large employers don’t have to offer the essential health benefits, but the vast majority do.

Exceptions to Availability

If you have an older "grandfathered" health plan that existed and hasn't changed much since 2010 when the Affordable Care Act became a law, your child may not be eligible for the preventive care described above. These older plans do not have to offer free preventive care. Some of them may, though, so always read a plan's summary of benefits before you enroll in it. In addition, short-term health plans – those providing coverage for less than 4 months – also do not have to provide preventive care or many of the other protections of the Affordable Care Act.

American Academy of Pediatrics: "Health Reform and the AAP: What the New Law Means for Children and Pediatricians" and "Bright Futures Guidelines Priorities and Screening Tables ,"

"Children's Health: Oral Health Risk Assessment Tool" and "Oral Health Risk Assessment Tool."

Children's Defense Fund: "What Does It Mean For Children?"

Georgetown University Health Policy Institute: "ACA Protects and Improves Access to Preventive Care for Children."

U.S. Department of Health and Human Services: "Early and Periodic Screening, Diagnostic, and Treatment" and "What if I have a grandfathered health insurance plan?"

American Cancer Society: "Health Insurance and Financial Assistance for the Cancer Patient."

Healthcare.gov: "10 Health Care Benefits Covered in the Health Insurance Marketplace."

CDC: "Autism Spectrum Disorders," " Recommendations to Prevent and Control Iron Deficiency in the United States."

Georgetown University Health Policy Institute Center for Children and Families: "ACA Protects and Improved Access to Preventive Care for Children," "ACA Protects and Improved Access to Preventive Care for Children."

HealthFinder.gov: "Talk to Your Doctor About Newborn Screening," "Protecting Your Family from Lead Poisoning," "Make the Most of Your Baby's Visit to the Doctor (0 to 11 months)," "Help Your Child Stay at a Healthy Weight."

U.S. Preventive Services Task Force: "Ocular Prophylaxis for Gonococcal Ophthalmia Neonatorum," "Screening for Sickle Cell Disease in Newborns," "Screening for Congenital Hypothyroidism," "Screening for Iron Deficiency Anemia-Including Iron Supplementation for Children and Pregnant Women," "Lead Levels in Childhood and Pregnancy," "Screening for Lipid Disorders in Children," "USPSTF A and B Recommendations." "Baby's First Test: What Are the Screening Procedures?"

HealthyChildren.org: "Purpose of Newborn Hearing Screening," "High Blood Pressure in Children."

Family Practice Notebook: "Pediatric Anemia."

Genetics Home Reference: "Congenital Hypothyroidism."

Kid's Health: "Iron-Deficiency Anemia."

University of Utah Department of Pediatrics: "Pediatric History and Physical Exam."

Pediatrics, July 1, 2006.

Autism Speaks: "Modified Checklist for Autism in Toddlers (M-CHAT)."

CDC: "About BMI for Children and Teens," "Recommended Immunization Schedule for Persons 0-18," "Infant Immunization FAQs," "About BMI for Children and TeensScreening and Diagnosis for Health Care Providers."

University of Utah Department of Pediatrics: "Pediatric History and Physical Exam."