I heard that plans have to cover preventive services without cost sharing. Does this include every preventive service and are there any limitations or exceptions?

Most health plans, including Marketplace plans, are required to cover a wide range of preventive services and may not impose cost-sharing (such as deductibles, copayments, or co-insurance). The ACA requires private plans to cover services under four broad categories:

• Evidence-based screenings and counseling
• Routine immunizations
• Childhood preventive services
• Preventive services for women

So long as the preventive service is performed by an in-network provider, is not billed separately from the office visit, and is the main reason for the office visit, then the visit and the preventive service must be covered by the insurer without cost-sharing.

Birth control for women is considered a preventive service. If you get your insurance through work and your employer is affiliated with a faith-based organization and has a religious objection to birth control, birth control might not be covered, or only certain methods may be covered. Click here for more information.

Also, if you are covered by a plan that was in effect on or before March 23, 2010, it may be a “grandfathered plan.” These plans are not required to cover preventive services, or they may require cost sharing. If you are not sure if your plan is grandfathered, check with your employer or your insurance plan.

In addition, short-term health plans do not have to provide benefits required by the ACA and may not cover preventive services. Health care sharing ministries, which are membership groups usually affiliated with a religion that help members pay for health care (not insurance), are also not subject to ACA benefit requirements.