Women’s Health

I heard that plans have to cover preventive services without cost sharing. Does this include every preventive service and are there any limits to what is covered?

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Your plan is required to cover a wide range of preventive services and may not impose cost-sharing (such as deductibles, copayments, or co-insurance)if you are enrolled in an ACA-compliant, non-grandfathered plan, including plans offered through the health insurance Marketplace.  The ACA requires private plans to provide coverage for services under four broad categories: evidence-based screenings and counseling, routine immunizations, childhood preventive services, and 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 will be covered by the insurer without cost-sharing.

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 without 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 insurance policies do not have to provide benefits required by the ACA and may not cover preventive services.

While we have made every effort to provide accurate information in these FAQs, people should contact the health insurance Marketplace or Medicaid agency in their state for guidance on their specific circumstances.

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