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|
|Abdominal Aortic Aneurysm Screening (USPSTF)||Men age 65 – 75 who have ever smoked||One-time screening for abdominal aortic aneurysm with ultrasonography in men age 65 – 75 who have ever smoked.||None||6/30/2015|
|Abnormal Blood Glucose and Diabetes Mellitus (Type 2) Screening (USPSTF)||Adults aged 40 to 70 who are overweight or obese.||Screening for abnormal blood glucose as part of cardiovascular risk assessment. Clinicians should offer or refer patients with abnormal blood glucose to intensive behavioral counseling interventions to promote a healthful diet and physical activity.||3/31/2016|
|Aspirin for the Prevention of Cardiovascular Disease and Colorectal Cancer (USPSTF)||Adults aged 50 to 59 years with risk factors.||Low-dose aspirin use to prevent colorectal cancer and cardiovascular events such as stroke.||Federal FAQs, Set 12, Q4: Aspirin, while available over the counter, must still be covered without cost-sharing only when prescribed by a health care provider.||
|Depression Screening (USPSTF)||All adults, including pregnant and postpartum women.||Screening for depression should be implemented with adequate systems in place to ensure accurate diagnosis, treatment, and follow-up.||1/31/2018|
|Hepatitis B Screening (USPSTF)||Adults at increased risk||Screening for hepatitis B virus infection in persons at high risk for infection.||None||5/31/2015|
|Hepatitis C Screening (USPSTF)||Adults at increased risk||Hepatitis C virus (HCV) infection screening in persons at high risk for infection and a 1-time screening for HCV to adults born between 1945 and 1965.||None||6/30/2014|
|Hypertension (High Blood Pressure) Screening (USPSTF)||All Adults||Screening for high blood pressure in the clinical setting and confirmation with measurement outside clinical setting, using other ambulatory or home monitoring systems.||10/31/2016|
|Latent Tuberculosis Infection (LTBI)||Asymptomatic adults 18 years and older at increased risk for tuberculosis:
||Screening tests include the Mantoux Tuberculin skin test and interferon-gamma release assays.
Depending on risk factors, screening frequency could range from one time only to annual screening.
|Weight Loss to Prevent Obesity-Related Morbidity and Mortality in Adults: Behavioral Interventions
|Adults with Body Max Index (BMI) of ≥30||Clinicians should offer or refer adults with a BMI of 30 or higher to intense, multicomponent behavioral interventions.||None||
Coverage for 2018 recommendation will take effect 9/30/2019.
Current coverage policy for 2012 recommendation in place since 6/30/2013
|Osteoporosis Screening (USPSTF)||Women aged 65+
Postmenopausal women younger than 65 at increased risk
|Screening for osteoporosis with bone measurement testing to prevent osteoporotic fractures
Screening for osteoporosis with bone measurement testing to prevent osteoporotic fractures in postmenopausal women younger than 65 at an increased risk for osteoporosis, as determined by a formal clinical risk assessment tool
|The 2018 recommendation updates the 2011 recommendation by adding a formal risk assessment tool for women younger than 65.||Coverage for 2018 recommendation will take effect 6/30/2019.
Current coverage policy for 2011 recommendation in place since 1/31/2012
|Statin Use for Prevention of Cardiovascular Disease (CVD)||Adults aged 40 – 75 without history of CVD who have 1 or more risk factors and a calculated 10-year CVD event risk of 10%+.||Use of a low to moderate dose statin for the prevention of CVD events and mortality.
Risk factor analysis includes screening for lipid disorders anduse of ACC/AHA CVD risk calculator to estimate 10-year risk.