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Frequently Asked Questions

Preventive Services

updated July 2013

What preventive services will I be able to receive without having any out-of-pocket expense? What are the covered services that are specific to women?
The lists of preventive services which are provided without cost-sharing (deductible, copays or coinsurance) is extensive, and covers services for children, adolescents and adults, as well as services specific to men and women. You can find a detailed list of preventive services at https://www.healthcare.gov/what-are-my-preventive-care-benefits. A separate list of preventive services specific to women is available at www.hrsa.gov/womensguidelines.
Are all health plans required to provide preventive services with no cost-sharing?
No, grandfathered plans are not required to offer any of the preventive services with no cost-sharing. All non-grandfathered plans must include the entire list of preventive services for men, women and children and may not require their members to pay deductibles, copays or coinsurance. If an existing plan were to lose its grandfather status, then it must begin to include these preventive services with no cost-sharing.
If one of the preventive services that I receive without cost-sharing provides a diagnosis for which I need additional treatment, is that recommended treatment also covered by the health plan without any cost to me?
No, only the screening or other preventive service specified by the federal government is provided with no cost to the plan member. When it comes to receiving recommended treatment services for any diagnosed condition, then any deductible, copay or coinsurance required by your benefits plan would apply to those services.
Are these preventive services provided at no cost to me regardless of whether I receive them in-network or out-of-network?
Health plans are only required to cover recommended preventive services received from an in-network provider; you may be required to pay deductibles, copay or coinsurance if you receive these services from a non-contracting provider.
By including contraceptives in the listing of preventive services for women, does that mean that I will be able to get my birth control pills for free?
The new guidelines require non-grandfathered health plans to provide all Food and Drug Administration-approved contraceptives as prescribed by your doctor, meaning that you could receive your prescription birth control pills with no cost-sharing. You should note, though, that your health plan is allowed the flexibility to control costs by, for example, requiring you to pay a copayment if you choose a brand-name drug when a generic drug is available, and is equally safe and effective.
My employer is a religious organization that opposes the use of artificial birth control methods and sterilization. Will my employer be required to provide this coverage?
No, religious employers for whom contraception is inconsistent with their tenets can choose to offer health insurance that does not cover contraception.
These preventive services are sometimes referred to as “free” in media reports. Is this an accurate term to describe preventive services?
While preventive services as outlined by the health care reform law might be “free” to the consumer at the time they are received – meaning they pay no out-of-pocket costs at that time – consumers should understand that these services are not truly “free.” The cost to receive these services will be reflected in a consumer’s insurance premium.
Will the list of preventive services be expanded in the future?
Yes, it is likely that the list of preventive services will be expanded in the future. Any future changes will be based on new recommendations from either the U.S. Preventive Services Task Force “A” or “B,” Advisory Committee of Immunization Practices, HRSA Guidelines for Preventive Care and Screenings for Infants, Children and Adolescents, or the Institute of Medicine. Health plans will have one year to implement any future recommendations that may be issued by the government and its advisory committees.

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