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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Most health plans, including Marketplace plans, other ACA-compliant individual plans, and employer-sponsored 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, 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, or they may require cost sharing. If you are not sure if your plan is grandfathered, check with your employer or your insurance plan.

If you are enrolled in an employer-sponsored plan and the employer has a religious or moral objection to contraceptives, your plan may not include contraceptive coverage. In addition, short-term health insurance policies 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.

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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