Nearly 7 in 10 Medicare Beneficiaries Did Not Compare Plans During Medicare’s Open Enrollment Period

Authors: Nancy Ochieng, Juliette Cubanski, Meredith Freed, and Tricia Neuman

Published: Sep 26, 2024

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Issue Brief

Each year, people with Medicare can review their coverage options and change plans during the annual Open Enrollment Period (October 15 to December 7). Medicare beneficiaries with traditional Medicare can compare and switch Medicare Part D stand-alone drug plans or join a Medicare Advantage plan, while enrollees in Medicare Advantage can compare and switch Medicare Advantage plans or elect coverage under traditional Medicare with or without a stand-alone drug plan. Beneficiaries have no shortage of plans to choose from: in 2024, the average Medicare beneficiary can choose among 43 Medicare Advantage plans and 21 Part D stand-alone prescription drug plans (PDPs).

The marketplace of Medicare private plans operates on the premise that people with Medicare will compare plans during the open enrollment period to select the best source of coverage, given their individual needs and circumstances. Coverage and costs vary widely among both Medicare Advantage plans and Part D prescription drug plans and can change from one year to the next, which could lead to unexpected and avoidable costs and disruptions in care for beneficiaries who do not review their options annually. For example, changes in Medicare Advantage provider networks could mean beneficiaries lose access to their preferred doctors, while changes in the list of covered drugs and cost-sharing requirements could result in higher out-of-pocket drug costs. Further, beneficiaries’ health care needs can change from one year to the next. Even without a change made by their plan or a change in health status, beneficiaries may be able to find a plan that better meets their individual needs or lowers their out-of-pocket costs.

In focus groups conducted by KFF, Medicare beneficiaries highlighted many of these factors, including out-of-pocket costs, access to specific doctors, and coverage of prescription drugs, as important in choosing their Medicare coverage. Yet, Medicare beneficiaries also expressed difficulty understanding and comparing the various plan options and being overwhelmed by a barrage of television ads – mostly for Medicare Advantage plans.

In this analysis, KFF examines the share of Medicare beneficiaries who reviewed their coverage and compared plans during the 2021 open enrollment period for coverage in 2022, and who made use of Medicare’s official information resources, as well as variations by demographic groups, based on an analysis of the 2022 Medicare Current Beneficiary Survey (the most recent year available).

Key Takeaways

Overall, nearly 7 in 10 (69%) Medicare beneficiaries did not compare their own source of Medicare coverage with other Medicare options offered in their area during the 2021 open enrollment period, while 31% did so. A larger share of beneficiaries in traditional Medicare than in Medicare Advantage did not compare their own source of coverage with other plans (73% vs 65%).
Among Medicare Advantage enrollees, more than 4 in 10 (43%) did not review their current plan’s coverage to check for potential changes in their plan’s premiums or other out-of-pocket costs, while the remainder (57%) did so. A similar share (44%) did not review their current plan for potential changes in the kinds of treatments, drugs, and services that would be covered in the following year.
Most enrollees in Medicare Advantage prescription drug plans (82%) and stand-alone prescription drug plan (PDPs) (69%) did not compare their plan’s drug coverage with drug coverage offered by other plans in their area.
Medicare’s official information resources are used by half or fewer of Medicare beneficiaries, with just a quarter (26%) reporting calling the toll-free number, 4 in 10 (42%) reporting visiting the Medicare website, and slightly more than half (54%) reporting reading some or parts of the Medicare & You handbook.

Nearly 7 in 10 Medicare Beneficiaries Did Not Compare Medicare Coverage Options During the Open Enrollment Period for 2022

Overall, most (69%) Medicare beneficiaries reported that they did not compare their current Medicare plan to other Medicare coverage options that were available during the 2021 open enrollment period for coverage in 2022 (Figure 1, Table 1). Among Medicare Advantage enrollees, nearly two-thirds of enrollees (65%) did not compare coverage options for 2022, even though year-to-year changes in Medicare Advantage plans, such as changes in provider networks or prior authorization requirements can affect enrollees’ access to care.

Nearly 7 in 10 Medicare Beneficiaries Did Not Compare Medicare Coverage Options During Open Enrollment Period for Coverage in 2022E

The share of Medicare beneficiaries who did not compare Medicare coverage arrangements was higher among certain subgroups, including beneficiaries with lower incomes and education levels, Hispanic beneficiaries, those dually-enrolled in Medicare and Medicaid, under age 65 with disabilities or ages 85 and older, and beneficiaries with a cognitive impairment (Figure 2, Appendix Table 1).

The Share of Medicare Beneficiaries Who Did Not Compare Medicare Coverage Options During Open Enrollment Was Higher Among Certain Subgroups

More Than 4 in 10 Medicare Advantage Enrollees Did Not Review Their Own Plan for Potential Changes in Covered Costs or Services for the Coming Year

For Medicare Advantage enrollees, premiums, cost sharing, and out-of-pocket limits can vary from year to year and across plans, with Medicare Advantage plans having the flexibility to modify cost sharing for most services, subject to limitations. Medicare Advantage plans may provide extra (“supplemental”) benefits that are not covered in traditional Medicare, but the type and scope of specific services often varies from one year to the next. Additionally, virtually all Medicare Advantage enrollees are in plans that impose prior authorization requirements for certain services, and these plans can alter the list of covered drugs, and broaden or narrow their network of physicians and other providers from one year to the next, subject to federal standards.

More than 4 in 10 (43%) Medicare Advantage enrollees did not review their current plan during the open enrollment period to see whether there would be changes for 2022 to their monthly premiums, deductibles, co-payments, or other out-of-pocket expenses, but the remaining 57% reported doing so (Figure 3, Appendix Table 2). Similarly, 44% of Medicare Advantage enrollees did not review their current plan for changes to the kinds of treatments, drugs, and services offered for their coverage in 2022.

The share of Medicare Advantage enrollees who did not review their own plan for changes in costs or services was higher among certain enrollees, including those with lower incomes and education levels, Black and Hispanic enrollees, individuals self-reporting fair or poor health, enrollees ages 85 and older, and those dually-eligible for Medicare and Medicaid coverage (Figure 3, Appendix Table 2).

For example, half of all Medicare Advantage enrollees reporting fair or poor health did not check to see if there was going to be a change in monthly premiums, deductibles or co-payments in their coverage, or any change in the kinds of treatments, drugs and services that would be covered. Nearly two-thirds of Hispanic (65%) and half of Black (50%) Medicare Advantage enrollees did not review their plan for changes in costs, with a similar pattern for changes in services (64% vs 48%, respectively). Additionally, nearly 60% of adults ages 85 and older did not review their plan for changes in costs (57%) or services (58%).

More Than Four in 10 Medicare Advantage Enrollees Did Not Review Their Current Medicare Plan For Changes in Costs or Services Covered in 2022; the Share Was Higher Among Certain Enrollees

Most Medicare Beneficiaries with Part D Prescription Drug Coverage Did Not Compare Their Plan’s Drug Coverage to Other Drug Coverage Options

Part D plan costs, including premiums, deductibles, and cost-sharing requirements can change from year to year and vary by plan. Additionally, Part D plans can also modify their formularies, including adding or dropping drugs from coverage, and adding or modifying utilization management requirements that apply to specific drugs, such as prior authorization and step therapy.

The prescription drug provisions of the Inflation Reduction Act include changes that will lower out-of-pocket costs for all Part D enrollees, including a new $2,000 cap on out-of-pocket spending starting in 2025. In response to these changes, it is possible that Part D plan sponsors may make changes to plan premiums, formularies and cost sharing, making it particularly important for beneficiaries to compare their prescription drug options during open enrollment.

About 8 in 10 (82%) enrollees in Medicare Advantage plans with prescription drug coverage (MA-PDs) did not compare the drug coverage offered by their own MA-PD to other MA-PDs in their area during the 2021 open enrollment period (Figure 4; Appendix Table 3). Among stand-alone prescription drug plan (PDP) enrollees, a lower share, 69% of enrollees, said they did not compare drug coverage offered by their current PDP to other PDPs.

Most Medicare Beneficiaries Did Not Compare the Drug Coverage Under Their Current Plan to Drug Coverage Offered by Other Medicare Plans

The share of beneficiaries with coverage under MA-PDs or PDPs who did not compare drug coverage offered for coverage in 2022 was higher among women, beneficiaries with lower incomes and education levels, Hispanic beneficiaries, beneficiaries ages 85 and older, and dual-eligible individuals (Appendix Table 3).

Medicare’s Information Resources Are Used by Half or Even Fewer Beneficiaries

Medicare provides information resources to help beneficiaries understand their Medicare benefits, coverage options, and costs, including the 1-800 Medicare toll free number, the Medicare.gov website, and the Medicare & You handbook that is provided each year to all Medicare beneficiaries. But these resources are not widely used, particularly the toll-free number (Figure 5, Appendix Table 4).

About a quarter (26%) of Medicare beneficiaries reported calling the 1-800-MEDICARE helpline for information, but the remaining three-quarters (74%) of Medicare beneficiaries reported either never calling the helpline for information (51%) or being unaware that this helpline existed (23%).
Four in 10 (42%) Medicare beneficiaries said they (or someone on their behalf) visited the official Medicare website for information, but more than half (58%) said they either never visited the website (36%) or they did not have access to the internet or had no one to access it for them (22%).
More than half (54%) of Medicare beneficiaries reported that they had read the Medicare & You handbook (thoroughly or some parts of the handbook), but 46% reported that either they did not read the handbook (31%) or they did not receive it or did not know if they had received it (15%).

The share of Medicare beneficiaries who used Medicare information sources was lower among certain subgroups, including Black beneficiaries, individuals ages 75 to 84, and dual-eligible individuals (Appendix Table 4).

Methods

This analysis uses survey data for community-dwelling Medicare beneficiaries from the Centers for Medicare & Medicaid Services (CMS) Medicare Current Beneficiary Survey (MCBS) 2022 Survey File.

The analysis of 1) the share of beneficiaries who compared Medicare plans during the open enrollment period for 2022 coverage, 2) the share of Medicare Advantage enrollees who reviewed their current coverage for changes in costs or services, and 3) the share of beneficiaries who used Medicare’s official information sources used questions from the Medicare Plan Beneficiary Knowledge topical segment. This analysis was weighted to represent the ever-enrolled Medicare population in 2022 using the topical survey weight KNSEWT and relevant replicate weights. The analysis of the share of beneficiaries who compared Medicare plans and the share of Medicare Advantage enrollees who reviewed their current coverage for changes in costs or services excluded beneficiaries who reported just enrolling in Medicare.

The analysis of MA-PD/PDP drug plan comparison used questions from the Rx Medication topical segment; similar as above, the analysis was weighted to represent the ever-enrolled Medicare population in 2022 using the topical survey weight RXSEWT and relevant replicate weights.

Both analyses excluded beneficiaries with Part A or Part B only, those with Medicare as secondary payer, and those living in long-term care facilities. All reported differences in the text are statistically significant at p<0.05.

Appendix

Percent of Medicare Beneficiaries Who Compared Their Current Plans With Other Plans During the Open Enrollment Period For 2022 Coverage, By Demographic Characteristics

Percent of Medicare Advantage Enrollees Who Reviewed Their Current Medicare Plan for Changes in Costs or Services During the Open Enrollment Period for 2022 Coverage

Percent of Medicare Beneficiaries Reporting Prescription Drug Plan Comparison During the Open Enrollment Period for 2022 Coverage

Percent of Medicare Beneficiaries Reporting Use of Medicare Official Resources During the Open Enrollment Period for 2022 Coverage

News Release

Nearly 7 in 10 Medicare Beneficiaries Do Not Compare Coverage Options During Open Enrollment

Published: Sep 26, 2024

With open enrollment less than a month away, a new KFF analysis suggests that the vast majority of the nation’s 67 million Medicare beneficiaries will not shop around among the coverage options for 2025 or switch plans. It’s a decision that could have a significant impact on enrollees’ coverage and costs.

The analysis of federal data shows that nearly 7 in 10 Medicare beneficiaries (69%) did not compare their Medicare coverage with other Medicare options during the program’s annual open enrollment period for coverage in 2022. Enrollees in traditional Medicare were slightly more likely to skip shopping around than those in Medicare Advantage plans (73% vs. 65%).

The Centers for Medicare & Medicaid Services recommends that beneficiaries compare their options because coverage and costs can vary widely, especially among Medicare Advantage plans that now enroll more than half of all eligible Medicare beneficiaries. From one year to the next, Medicare Advantage plans can change their premiums, cost-sharing requirements, provider networks, or prior authorization requirements. For beneficiaries who simply stay put in their existing plan, such changes could lead to unexpected, avoidable costs and disruptions in care.The new analysis examined the subset of Medicare beneficiaries enrolled in a Medicare Advantage plan, finding that 43% of enrollees did not review their own plan’s coverage during the open enrollment period to see whether there would be changes for 2022 to their monthly premiums, deductibles, co-payments, or other out-of-pocket expenses. The share not reviewing their own plan for changes in costs was even higher among enrollees in fair or poor self-assessed health (50%), enrollees who are Black (50%) or Hispanic (65%), and enrollees ages 85 and older (57%).Similarly, 44% of Medicare Advantage enrollees did not review their current plan for changes to the kinds of treatments, drugs, and services offered for 2022.New changes for 2025 include prescription drug provisions in the Inflation Reduction Act of 2022 that will lower out-of-pocket costs for all Part D enrollees, including a new $2,000 cap on out-of-pocket spending starting in January. In response, Part D plan sponsors may make changes to plan premiums, formularies, and cost sharing — making it especially important for beneficiaries to compare their prescription drug options during open enrollment.

In the past, many have not. The analysis shows that 82% of enrollees in Medicare Advantage prescription drug plans and 69% of enrollees in stand-alone Part D prescription drug plan did not compare their plan’s drug coverage with drug coverage offered by other plans in their area for 2022.

More broadly, relatively few beneficiaries use Medicare’s official information resources. The analysis finds that just a quarter (26%) reported calling the toll-free 1-800-Medicare helpline, four in 10 (42%) reported visiting the Medicare website, and slightly more than half (54%) reported reading some or parts of the Medicare & You handbook.

Also released today is KFF’s What to Know about the Medicare Open Enrollment Period and Medicare Coverage Options. It provides information about the kinds of changes Medicare beneficiaries can make to their coverage, how supplemental coverage can factor into decisions, how Medicare supports for low-income people relates to coverage decisions, how the features of traditional Medicare compare to Medicare Advantage, and how prescription drug coverage plans vary.

The Medicare open enrollment period runs from October 15 through December 7.

Contact

Craig Palosky

cpalosky@kff.org

VOLUME 7

September 26, 2024

Political Rhetoric Spreads Misinformation About Fentanyl

This is Irving Washington and Hagere Yilma. We direct KFF’s Health Misinformation and Trust Initiative and on behalf of all of our colleagues across KFF who work on misinformation and trust we are pleased to bring you this edition of our bi-weekly Monitor.

KFF Authors:

Irving Washington , and

Hagere Yilma

Summary

In this edition, we look at how political rhetoric is driving misinformation about fentanyl and immigration. We also highlight the legal implications of fentanyl-laced counterfeit pills sold on social media, address myths about opioid exposure, and discuss how AI may help counter these narratives.

Featured

In his latest Beyond the Data column, KFF CEO Drew Altman examines how media coverage can inadvertently amplify politicians’ misinformation about immigrants. He cites a recent incident in Springfield, Ohio, where false claims about Haitian immigrants, initially made by political candidates, gained traction through media coverage. Altman observes that some politicians are exploiting feelings of alienation among certain Americans by scapegoating immigrants. This misinformation can have serious consequences, especially for Black immigrants who face both racism and anti-immigrant sentiment. He emphasizes that the media must be careful when reporting on such political falsehoods, as repeated coverage showing clips of false statements, even if followed by fact checking, can unintentionally reinforce misinformation.

Recent Developments

Latest KFF Poll Explores Exposure, Belief, and Impact of Misinformation About Immigrants

The latest KFF Health Misinformation Tracking Poll (conducted before the September 10 presidential debate) highlights how misinformation about immigrants is being shared by politicians leading up to the election, with many adults exposed to both false and true claims but remaining unsure of their truthfulness. The September Health Misinformation Tracking Poll found that large majorities of adults have heard elected officials or candidates make the false claims that immigrants are causing an increase in violent crime (80%) or taking jobs and increasing unemployment for U.S.-born adults (74%; Figure 1). While a majority have heard the true statement that immigrants help to fill labor shortages in some industries (69%), far fewer have heard candidates or elected officials make the true claim that immigrants pay billions in taxes annually (31%).

A Majority of Adults, Including Similar Shares Across Partisans, Say They Have Heard False Claims About Immigrants From Elected Officials or Candidates

Despite this exposure, most people say these statements are either “probably true” or “probably false,” reflecting widespread uncertainty (Figure 2). However, Republicans are far more likely than Democrats or independents to say false claims about immigrants are “definitely true.” Additionally, about half of U.S. adults, including a similar share of immigrants, either incorrectly believe undocumented immigrants are eligible for federally funded health insurance programs or say they are unsure. This misinformation has implications for immigrant health and well-being. The poll also found that nearly four in ten immigrants (36%), including nearly half of Asian immigrants (45%), say former President Trump’s rhetoric has negatively impacted the way they are treated in the U.S. On the other hand, most immigrants (72%) say Vice President Harris’s statements have not affected their treatment, while about one in five say her rhetoric has had a positive effect.

Most Adults Are Uncertain When it Comes to the Accuracy of Both True and False Statements About Immigrants

Politicians Incorrectly Link Fentanyl to Migration to Garner Support for Immigration Policy

During this election season, politicians are sharing misinformation about fentanyl and migration to instill fear and promote stricter border policies. Former President Donald Trump and Vice Presidential Candidate JD Vance have repeatedly claimed that undocumented immigrants are responsible for the influx of fentanyl into the U.S., criticizing President Biden and Vice President Harris’ immigration policy and suggesting that building border walls could reduce drug flow. These claims are misleading and not new. An NPR-Ipsos poll from 2022 found that nearly 4 in 10 Americans believe that “most of the fentanyl entering the U.S. is smuggled in by unauthorized migrants crossing the border illegally”. In reality, federal data analyzed by KFF indicates that most fentanyl enters the U.S. through legal ports of entry and is trafficked primarily by U.S. citizens, not migrants.

As fentanyl continues to drive overdose deaths in the U.S., these misleading claims are resonating with some grieving parents who have lost children to fentanyl overdoses and are looking for decisive action against the opioid crisis. A new KFF analysis shows that fentanyl has driven a 23-fold increase in opioid deaths over the past decade, making it the primary cause of overdose fatalities, despite a decline in overall opioid deaths in late 2023. But experts argue that stricter immigration policies will not effectively combat the opioid epidemic. This type of rhetoric misplaces blame, contributing to stigmatization and harmful policies that adversely affect immigrant health. Focusing on this false link neglects the real factors driving fentanyl and opioid overdoses in the U.S., such as misconceptions about treatments for opioids.

Fentanyl-Laced Fake Drugs on Social Media Raises Questions About Accountability

Social media platforms have increasingly contributed to the rise of fentanyl use among youth. Platforms like Instagram, Snapchat, and Telegram have become key venues for drug distribution, allowing young users to order illicit substances, often without knowing they’re laced with fentanyl. Even though social media companies are trying to crack down on drug sales, experts say it’s not enough to keep users safe. Some grieving parents, who’ve lost children to fentanyl-laced pills, are suing companies like Snap for negligence in these tragic fatalities. This legal battle has broader implications for Section 230, which currently provides immunity to online platforms for content posted by users. If these cases succeed, it could lead to stricter rules and more accountability for social media companies.

One way to determine if prescription drugs contain fentanyl is by using fentanyl test strips. Although there is uncertainty about how consistently fentanyl test strips detect fentanyl across brands, lots, and drug combinations, they can still serve as effective harm reduction measures by identifying fentanyl and its analogs in drug samples at low concentrations. Unfortunately, a widespread myth persists that fentanyl contamination is impossible to detect, which keeps many from using these strips. Critics also argue that making fentanyl test strips available might encourage drug use, causing some states to classify them as drug paraphernalia. But harm-reduction evidence shows they prevent overdoses without increasing consumption and a KFF Issue Brief explains that some states are changing their policies to allow access to fentanyl test strips because of the rise of illicit fentanyl in drug supplies. By spreading the myth that fentanyl contamination is undetectable or leads to more drug use, individuals overlook practical solutions that could mitigate the risk and protect vulnerable populations.

Emerging Misinformation Narratives

Myths About Fentanyl Exposure

A common myth surrounding fentanyl is that simply touching it can be fatal. This fear has been spread by some media reports and misinformed statements. Fentanyl is a powerful opioid, but it isn’t absorbed through the skin or through casual contact.

There have been several high-profile cases where police officers or first responders claimed to have collapsed or overdosed just by touching fentanyl, but medical experts have consistently debunked these reports. In July 2023, multiple local news outlets reported on incidents involving police officers who claimed to have been exposed to fentanyl during their duties. One officer in Indiana stated they had passed out after accidentally inhaling the drug, while another in Colorado reported collapsing after touching it. Similar claims have surfaced in recent years, often sparking discussions on social media. While some users express concern, others question the validity of these reports. For example, in response to the recent incidents, a doctor shared a popular post on X stating, that fentanyl cannot be accidentally inhaled, as it must be snorted or vaporized.

The misconception that simply touching or inhaling fentanyl can lead to overdose can be traced back to an advisory statement issued by the DEA in 2016. Even though experts have repeatedly debunked these myths, public fear of fentanyl remains high. Widespread concerns about the drug are understandable, as fentanyl is involved in more than 70 percent of U.S. overdose deaths, but false narratives about the drug may be drowning out factual information intended to prevent fentanyl-related deaths.

Research Updates

A study in Journalism Studies that examined media coverage of misinformation during the 2016 and 2020 U.S. presidential elections offers insight into how media outlets addressed election-related false claims. The study identified three core strategies for correcting election-related misinformation: emphasizing correct information without repeating the false claims, adopting a more assertive tone to debunk inaccuracies, and using credible sources to appeal to diverse audiences, including skeptics. As health misinformation continues to underlie political rhetoric leading up to the election, these media approaches could help shape public understanding and counteract harmful narratives.

Source: Juarez Miro, C., & Anderson, J. (2024). Correcting False Information: Journalistic Coverage During the 2016 and 2020 US Elections. Journalism Studies, 25(2), 218-236.

Debunking Misinformation May Be More Effective Than Prebunking

A study published in Nature found that debunking misinformation is slightly more effective than prebunking when it comes to correcting false claims. Researchers tested both strategies on over 5,000 participants across multiple European countries, examining how these interventions impacted belief in misinformation. While both methods worked, debunking — delivered after people were exposed to false claims — had a small advantage. However, the study also highlighted the role of trust: debunking was less effective when participants had low trust in the source delivering the correction, emphasizing that trust in institutions remains a factor in countering misinformation effectively.

Source: Bruns, H., Dessart, F. J., Krawczyk, M., Lewandowsky, S., Pantazi, M., Pennycook, G., … & Smillie, L. (2024). Investigating the role of source and source trust in prebunks and debunks of misinformation in online experiments across four EU countries. Scientific Reports, 14(1), 20723.

AI and Emerging Technologies

Personalized AI Debunking: A New Approach to Countering Conspiracy Theories

Personalizing debunking efforts can effectively counter conspiracy theories by tailoring arguments to address the specific evidence individuals believe supports their views. A recent study published in Science found that when participants engaged in a personalized, in-depth dialogue with an AI tool designed to refute conspiracy theories, their belief in those conspiracies decreased significantly, with effects lasting for months. This approach challenges the notion that conspiracy beliefs are impervious to change and suggests that AI tools, which can sustain individualized, evidence-based conversations, may be powerful resources for mitigating harmful beliefs.

About The Health Information and Trust Initiative: the Health Information and Trust Initiative is a KFF program aimed at tracking health misinformation in the U.S., analyzing its impact on the American people, and mobilizing media to address the problem. Our goal is to be of service to everyone working on health misinformation, strengthen efforts to counter misinformation, and build trust.

View all KFF Monitors

The Monitor is a report from KFF’s Health Information and Trust initiative that focuses on recent developments in health information. It’s free and published twice a month.

Support for the Health Information and Trust initiative is provided by the Robert Wood Johnson Foundation (RWJF). The views expressed do not necessarily reflect the views of RWJF and KFF maintains full editorial control over all of its policy analysis, polling, and journalism activities. The Public Good Projects (PGP) provides media monitoring data KFF uses in producing the Monitor.

ACA Preventive Services Tracker

Pregnancy-Related Preventive Services for Adults Covered by the ACA

Last Updated on June 27, 2025

The Affordable Care Act (ACA) requires most private health insurance plans and Medicaid ACA expansion programs to cover many recommended preventive services without any patient cost-sharing, including pregnancy-related services and supports such as: prenatal visits, folic acid, anxiety and depression screenings, screenings and medication for preeclampsia, STI tests, smoking cessation support, and breastfeeding and lactation counseling and supplies.

The required services are recommended by the U.S. Preventive Services Task Force (USPSTF)and the Health Resources and Services Administration (HRSA) based on recommendations issued by the Women’s Preventive Services Initiative. The Advisory Committee on Immunization Practices recommends vaccines for adults and children that must also be covered without cost-sharing.

The table below presents detailed information on pregnancy-related preventive services for adults covered under the ACA, including a summary of the recommendation, the target population, effective date of coverage, and related coverage clarifications.

ACA Preventive Services Tracker

Sexual and Reproductive Health Related Preventive Services for Adults Covered by the ACA

Last Updated on June 27, 2025

The Affordable Care Act (ACA) requires most private health insurance plans and Medicaid ACA expansion programs to cover preventive services related to sexual and reproductive health with no cost-sharing. These include—but are not limited to—contraceptive services and supplies for women, as well as counseling and testing for sexually transmitted infections (STIs) and human immunodeficiency virus (HIV), and pre-exposure prophylaxis (PrEP) for HIV prevention.

The required services are recommended by the U.S. Preventive Services Task Force (USPSTF) and the Health Resources and Services Administration (HRSA) based on recommendations issued by the Women’s Preventive Services Initiative. The Advisory Committee on Immunization Practices recommends vaccines for adults and children that must also be covered without cost-sharing.

The table below presents detailed information on sexual and reproductive health related preventive services that are covered under the ACA, including a summary of the recommendation, the target population, effective date of coverage, and related coverage clarifications.

ACA Preventive Services Tracker

Immunizations for Adults Covered by the ACA

Last Updated on June 27, 2025

Federal law requires most private health insurance plans and Medicaid programs to cover the full cost of recommended immunizations for adults with no cost-sharing. Vaccine and booster recommendations may vary by age and population. Some of the recommended vaccines that are covered in full, at least for some population groups, are for COVID-19, Human papillomavirus (HPV), measles-mumps-rubella (MMR), and Influenza along with many of the traditional childhood vaccinations.

The Advisory Committee on Immunization Practices (ACIP) develops recommendations for vaccine use to prevent the spread of diseases caused by infections and viruses.

The table below presents detailed information on immunizations for adults covered under the ACA, including a summary of the recommendation, the target population, effective date of coverage, and related coverage clarifications. Ongoing litigation over the scope of the preventive services requirement in the case, Braidwood Management Inc. v. Becerra, could affect coverage policy of preventive health services in the future.

ACA Preventive Services Tracker

Health Promotion Preventive Services for Adults Covered by the ACA

Last Updated on June 27, 2025

The Affordable Care Act (ACA) requires most private health insurance plans and Medicaid ACA expansion programs to cover the full cost of several preventive services related to health promotion, such as counseling on healthy diet, obesity prevention, and alcohol use. Plans must also cover screening for intimate partner violence, urinary incontinence, and checkup visits for women.

The table below presents detailed information on clinical preventive services related to health promotion for adults covered under the ACA, including a summary of the recommendation, the target population, effective date of coverage, and related coverage clarifications.

ACA Preventive Services Tracker

Chronic Condition Preventive Health Services for Adults Covered by the ACA

Last Updated on June 27, 2025

The Affordable Care Act (ACA) requires most private health insurance plans and Medicaid ACA expansion programs to cover many recommended preventive services without any patient cost-sharing, including services for prevention and early detection of risks associated with chronic conditions, such as heart disease, diabetes, obesity, hepatitis, anxiety, and depression.

The required services for adults are recommended by the U.S. Preventive Services Task Force (USPSTF)and the Health Resources and Services Administration (HRSA) based on recommendations issued by the Women’s Preventive Services Initiative. The Advisory Committee on Immunization Practices recommends vaccines for adults and children that must also be covered without cost-sharing.

The table below presents detailed information on preventive health services related to chronic conditions for adults covered under the ACA, including a summary of the recommendation, the target population, effective date of coverage, and related coverage clarifications.

ACA Preventive Services Tracker

Last Updated on June 27, 2025

The Affordable Care Act (ACA) requires most private health insurance plans and Medicaid ACA expansion programs to cover many recommended health care preventive services for adults without any patient cost-sharing, including preventive services for specific conditions.

Select from the categories below for detailed information on preventive services for each condition covered under the ACA for adults, including a summary of the recommendation, the target population, effective date of coverage, and related coverage clarifications.

The required health services for adults are recommended by the U.S. Preventive Services Task Force (USPSTF) and the Health Resources and Services Administration (HRSA) based on recommendations issued by the Women’s Preventive Services Initiative. The Advisory Committee on Immunization Practices recommends vaccines for adults and children that must also be covered without cost-sharing.

ACA Preventive Services Tracker

Cancer-Related Preventive Health Services for Adults Covered by the ACA

Last Updated on June 27, 2025

The Affordable Care Act (ACA) requires most private health insurance plans and Medicaid ACA expansion programs to cover many recommended preventive services without any patient cost-sharing, including the following cancer-related screening tests: mammograms, preventive medications and genetic counseling for breast cancer, colonoscopies for colon cancer screening, pap tests for detection of cervical cancer, CT test to screen for lung cancer, and behavioral counseling on skin cancer.

The required services for adults are recommended by the U.S. Preventive Services Task Force (USPSTF) and the Health Resources and Services Administration (HRSA) based on recommendations issued by the Women’s Preventive Services Initiative. The Advisory Committee on Immunization Practices recommends vaccines for adults and children that must also be covered without cost-sharing.

The table below presents detailed information on cancer-related screening and preventive services covered under the ACA for adults, including a summary of the recommendation, the target population, effective date of coverage, and related coverage clarifications.

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Nearly 7 in 10 Medicare Beneficiaries Did Not Compare Plans During Medicare’s Open Enrollment Period