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|
|Unhealthy Alcohol Use in Adolescents and Adults: Screening and Behavioral Counseling Interventions (USPSTF)||Adults 18 and older, including pregnant women||Screening for alcohol misuse in primary care settings. Clinicians recommended to provide persons engaged in risky or hazardous drinking with brief behavioral counseling interventions.||None||
Coverage for 2018 recommendation will take effect 11/30/2019
Current coverage policy for 2013 recommendation in place since 5/31/2014
|Healthful Diet and Physical Activity for Cardiovascular Disease (CVD): Behavioral Counseling (USPSTF)||Adults with CVD risk factors||Clinician referral for overweight or obese adults who have other cardiovascular disease risk factors to behavioral counseling interventions for healthful diet and physical activity.||None||8/31/2015|
|Falls Prevention in Older Adults (USPSTF)||Community-dwelling adults, age 65+ at increased risk for falls||Exercise or physical therapy.||The 2018 recommendation updates the 2012 recommendation, which included Vitamin D supplementation.||
Coverage for 2018 recommendation will take effect 4/30/2019
Current coverage policy for the 2012 recommendation in place since 5/31/2013
|Intimate Partner Violence Screening and Counseling (HRSA & USPSTF)||Women||Screening and counseling for interpersonal and domestic violence. Recommended that clinicians provide or refer women with positive screenings to intervention services.||Federal FAQ, Set 12, Q11: screening may consist of a few brief open-ended questions, and can be facilitated by the use of forms, brochures, or other tools. Counseling provides basic information and result in referrals.||HRSA: 8/1/2012 USPSTF: 1/31/2014|
|Tobacco Smoking Cessation: Behavioral and Pharmacotherapy Interventions (USPSTF)||All adults||Discussion with clinicians on tobacco use and cessation, behavioral interventions and FDA-approved pharmacotherapy for cessation to adults who use tobacco products.||Federal FAQ, Set 19, Q5: At least 2 cessation attempts per year covered without cost sharing. One “attempt” includes 4 counseling sessions of at least 10 minutes each, including telephone, group, and individual counseling without prior authorization; and all FDA-approved cessation medications for a 90 day regimen as prescribed by a clinician without prior authorization.||9/23/2010|
|Well Woman Visit (HRSA)||Women||At least one visit annually for women to receive recommended preventive services that are age and developmentally appropriate, including preconception and prenatal care.||Federal FAQs: Set 12, Q10: multiple visits may be necessary, as determined by a clinician. Set 26, Q6 clarifies that prenatal and preconception care is part of a well-woman visit.||8/1/2012|