Preventive Services Use Among People with Private Insurance Coverage

This analysis of claims data estimates that six in ten people with private health insurance – or about 100 million people – used at least one preventive service covered without any out-of-pocket costs through a provision of the Affordable Care Act (ACA) in a typical year prior to the COVID-19 pandemic (2018).

The provision that requires most private health plans to cover many preventive services without any cost-sharing for their enrollees is being challenged in federal court. The U.S. District Court in the Northern District of Texas in September concluded that aspects of the requirement were unconstitutional and violated religious rights but has allowed the provision to remain in effect while it considers a remedy.

The most commonly received preventive services include vaccinations, well woman and well child visits, and screenings for heart disease, cervical cancer, diabetes, and breast cancer. COVID-19 vaccines are also provided at no cost to patients under the ACA’s preventive services requirement, though how many people will take them up in the future is uncertain.

Women and children are more likely than men to have used at least one no-cost preventive service through their private insurance. The analysis also looks at variations in the use of preventive services in the large group, small group and individual markets. It is available through the Peterson-KFF Health System Tracker, an online information hub that monitors and assesses the performance of the U.S. health system.