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
Screening mammography every 2 years
Coverage requirement and clinical recommendation differ:
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||
|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.||Current coverage policy for FOBT, Sigmoidoscopy, and Colonoscopy in place since 9/23/2010.
Coverage requirement for other tests takes effect for plan years beginning on/after June 30, 2017
|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|