Filling the need for trusted information on national health issues…

Preventive Services Tracker

The Affordable Care Act (ACA) requires new private health insurance plans to cover many recommended preventive services without any patient cost-sharing. For adults, the required services are recommended by the U.S. Preventive Services Task Force (USPSTF), the Advisory Committee on Immunization Practices (ACIP), and the Health Resources and Services Administration (HRSA) based on recommendations issued by the Institute of Medicine Committee on Women’s Clinical Preventive Services.  As new recommendations are issued or updated, coverage must commence in the next plan year that begins on or after exactly one year from the recommendation’s issue date.

This tracker presents up-to-date information on the adult preventive services nongrandfathered private plans must cover, by condition, including a summary of the recommendation, the target population, the effective date of coverage, and related federal coverage clarifications.

For more information, see the fact sheet Preventive Services Covered by Private Health Plans under the Affordable Care Act.

Required Preventive Service Target Population Recommendation Coverage Clarifications Effective Date of Coverage
BRCA-Related Cancer: Risk Assessment, Genetic Counseling and Genetic Testing (USPSTF) Women at increased risk Screening for women who have family members with breast, ovarian, tubal, or peritoneal cancer for increased risk of BRCA gene mutations. Women with a positive screening should receive counseling and, possibly, BRCA testing. Federal FAQs, Set 12, Q6: genetic counseling and BRCA testing are covered without cost sharing. Set 26, Q1: recommendation applies to asymptomatic women, including women who previously had cancer unrelated to BRCA.  12/31/2014
Breast Cancer Screening (USPSTF)
Women age 50-74

(2016 recommendation)

Screening mammography every 2 years
(2016 recommendation)
Coverage requirement and clinical recommendation differ:
The ACA, Section 2713(a)(5), states that plans must cover mammography per the 2002 USPSTF recommendation, which recommends screening every 1-2 years for women 40 and older.  The PALS Act of 2015 extends this coverage policy through 2017.
Current coverage policy in place since 9/23/2010.

 

Coverage requirement for 2016 recommendation takes effect January 2018, following sunset of PALS Act.

Breast Cancer: Medications for Risk Reduction (USPSTF) Women age 35+ at increased risk Breast cancer medications, such as tamoxifen or raloxifene, for some asymptomatic women at increased risk. Federal FAQs, Set 18, Q1: plans must cover preventive medications for eligible women with risk factors without cost-sharing. 9/30/2014
Cervical Cancer Screening (USPSTF) Women age 21 – 65 Pap smear every 3 years for women age 21 – 65 or combination of Pap smear and HPV test every 5 years for women age 30 to 65. Federal FAQs, Set 12, Q12: high-risk HPV DNA testing for women with normal Pap results should begin at age 30 and not be administered more than once every 3 years. 3/31/2013
Cervical Cancer Screening: Human Papillomavirus Testing (HRSA) Women age 30+ HPV test with Pap test in women with prior normal Pap results, beginning at age 30 and occurring no more frequently than every 3 years. Federal FAQs, Set 12, Q12: high-risk HPV DNA testing for women with normal Pap results should begin at age 30 and not be administered more than once every 3 years. 8/1/2012
Colorectal Cancer Screening (USPSTF) Adults age 50 – 75 Fecal occult blood testing, sigmoidoscopy, or colonoscopy in adults age 50 – 75. Federal FAQs, Set 12, Q5: insurers cannot impose cost-sharing for polyp removal when screening colonoscopy performed. Set 26 Q7: cannot charge cost sharing for anesthesia that clinician has deemed medically appropriate for a preventive colonoscopy. 9/23/2010
Lung Cancer Screening (USPSTF) Adults age 55 – 80 with history of smoking Annual low-dose computed tomography (LDCT) in adults age 55 – 80 with a 30 pack-year smoking history and currently smoke or have quit within the past 15 years. For those who smoke, tobacco cessation counseling is recommended. None 13/31/2014
Skin Cancer Counseling (USPSTF)  Individuals age 10-24, fair skinned Counseling for those with fair skin on minimizing exposure to UV radiation. None 7/31/2013
Chronic Conditions

The Henry J. Kaiser Family Foundation Headquarters: 2400 Sand Hill Road, Menlo Park, CA 94025 | Phone 650-854-9400
Washington Offices and Barbara Jordan Conference Center: 1330 G Street, NW, Washington, DC 20005 | Phone 202-347-5270

www.kff.org | Email Alerts: kff.org/email | facebook.com/KaiserFamilyFoundation | twitter.com/KaiserFamFound

Filling the need for trusted information on national health issues, the Kaiser Family Foundation is a nonprofit organization based in Menlo Park, California.