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Preventive Services Tracker

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 (HRSA) Women ages 40 to 74 with average-risk for breast cancer Screening mammography at least every 2 years and as frequently as once a year 12/31/2017
Breast Cancer Screening (USPSTF)
Women age 50-74

 

Screening mammography every 2 years
1/31/2018
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 21 to 29.

Pap smear every 3 years for women 30 to 65, or a high-risk HPV (hrHPV) test every 5 years, or a Pap smear in combination with a hrHPV test every 5 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. Coverage for the 2018 recommendation will take effect 8/31/2019.

Current coverage policy for the 2012 recommendation has been in place since 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
  • Fecal occult blood testing (FOBT) (yearly)
  • Flexible Sigmoidoscopy (every 5 years)
  • Colonoscopy (every 10 years)
  • Fecal Immunochemical testing (FIT) (yearly)
  • CT colonography (every 5 years)
  • FIT DNA (every 1-3 years)
  • Flexible sigmoidoscopy with FIT (yearly & every 10 years)
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. 6/30/2017
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 12/31/2014
Skin Cancer Prevention: Behavioral Counseling Children, parents of young children, adolescents and young adults (persons aged 6 months to 24 years) with fair skin type Counsel about minimizing exposure to UV radiation to reduce their risk of skin cancer The 2018 recommendation updates the 2012 recommendation, which limited the age range of the target population to individuals 10 to 24 years old.

Coverage for the 2018 recommendation will take effect 3/31/2019.

Current coverage policy for the 2012 recommendation in place since 7/31/2013.

Chronic Conditions

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Filling the need for trusted information on national health issues, the Kaiser Family Foundation is a nonprofit organization based in Menlo Park, California.