updated July 2013
One goal of the Patient Protection and Affordable Care Act (PPACA) is to encourage more Americans to seek those preventive services which can lead to early detection and treatment of a variety of chronic diseases and other costly medical conditions. To accomplish this, the law requires non-grandfathered health plans to provide a specific list of preventive services with no cost-sharing, meaning consumers will not pay deductibles, copays or coinsurance for the preventive services outlined.
The list of preventive services includes services for Americans of all ages, as well as services specific to women. A few of the many preventive services which are available without cost-sharing are:
The additional preventive services for women that are covered without cost sharing by non-grandfathered health plans include:
No-cost sharing coverage for preventive services must follow recommendations by the U.S. Preventive Services Task Force “A” or “B,” Advisory Committee of Immunization Practices and HRSA Guidelines for Preventive Care and Screenings for Infants, Children and Adolescents. Additional guidelines specific to women’s services were recommended by the independent Institute of Medicine (IOM).
For a more complete list of preventive services, please visit https://www.healthcare.gov/what-are-my-preventive-care-benefits. For additional information regarding preventive services specific to women, please visit: www.hrsa.gov/womensguidelines.
The rules governing coverage of preventive services do allow health plans to use reasonable medical management to help define the nature of the covered service. Health plans retain the flexibility to control costs and promote efficient delivery of care by, for example, continuing to charge cost-sharing for branded drugs if a generic version is available and is just as effective and safe for the patient to use. In addition:
Health plans will have one year to implement any future recommendations that may be issued by the government and its advisory committees.