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 (2015 recommendation).||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 (2015 recommendation).||The 2015 recommendation updates a 2008 version that recommends screening for type 2 diabetes in adults with blood pressure greater than 135/80 mm Hg.||Coverage requirement for the 2015 recommendation takes effect for plan years beginning on/after October 31, 2016.
Current coverage policy for 2008 recommendation in place since 9/23/2010.
|Aspirin for the Prevention of Cardiovascular Disease and Colorectal Cancer (USPSTF)||Adults aged 50 to 59 years with risk factors (2016 recommendation).||Low-dose aspirin use to prevent colorectal cancer and cardiovascular events such as stroke (2016 recommendation).||The 2016 recommendation updates a 2009 version that recommends aspirin use to lower risk of cardiovascular disease in men and women.
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.
Coverage requirement for 2016 recommendation takes effect for plan years beginning on/after April 30, 2017.
Current coverage policy for the 2009 recommendation in place since 9/23/2010.
|Depression Screening (USPSTF)||All adults, including pregnant and postpartum women. (2016 recommendation)||Screening for depression should be implemented with adequate systems in place to ensure accurate diagnosis, treatment, and follow-up. (2016 recommendation)||The 2016 recommendation updates an earlier version by explicitly emphasizing the inclusion of pregnant and postpartum women and by assuming that supports for follow-up are in place in clinical settings.||The 2016 recommendation made changes that affect clinical practice, but do not affect the coverage requirement, which has been in place since 9/23/2010.|
|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 (2015 recommendation).||The 2015 recommendation reaffirms a 2007 recommendation to screen all adults and adds the recommendation to confirm with measurements taken outside of the clinical setting.||
Coverage requirement for the 2015 recommendation takes effect for plan years beginning on/after October 31, 2016.
Current coverage policy for 2007 recommendation in place since 9/23/2010.
|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.
Plan years beginning on/after September 6, 2017.
|Obesity Screening and Management (USPSTF)||All adults||Obesity screening, and referral for patients with BMI of >30 to behavioral interventions.||None||6/30/2013|
|Osteoporosis Screening (USPSTF)||Women age 65+, younger women at increased risk||Bone measurement tests using DXA in women aged 65+ years and in younger women at higher risk for fracture.||None||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.