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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
Haemophilus Influenza Type b (ACIP) Adults with risk factors 1 – 3 doses recommended for adults with risk factors (based on medical, occupational, lifestyle, or other indication). None* 9/23/2010
Hepatitis A (ACIP) Adults with risk factors 2 doses recommended for adults with risk factors (based on medical, occupational, lifestyle, or other indication). None* 9/23/2010
Hepatitis B (ACIP) Adults with risk factors 3 doses recommended for adults with risk factors (based on medical, occupational, lifestyle, or other indication). None* 9/23/2010
Human Papillomavirus (HPV) (ACIP) Both women age 18 – 26 and men age 18 – 21 not previously vaccinated; at-risk men age 22 – 26 3 dose series recommended for some men and women who are not pregnant and who have not previously finished the vaccination series. None* 9/23/2010 for females; 12/23/2012 for males
Influenza (ACIP) All adults 1 dose recommended annually for all adults who lack documentation of vaccination or have no evidence of previous infection. It is recommended that pregnant women at some other individuals receive the inactivated influenza vaccine. None* 9/23/2010
Measles, Mumps, and Rubella (MMR) (ACIP) Adults age 18 – 58 1 – 2 doses recommended for nonpregnant adults who lack documentation of vaccination or have no evidence of previous infection, and based on medical, occupational, lifestyle, or other indication. None* 9/23/2010
Meningococcal (ACIP) Adults with risk factors 1 or more doses of the meningococcal vaccination recommended for adults with risk factors (based on medical, occupational, lifestyle, or other indication). None* 9/23/2010
Pneumococcal Vaccines (ACIP) Adults with risk factors; adults age 65+ 1 dose recommended for adults age 65+ and for adults < 65 if other risk factor present (e.g., based on medical, occupational, lifestyle or other indication). None* 9/23/2010
Tetanus Diphtheria (Td) Booster, Tetanus, Diptheria, and Pertussis (Tdap) (ACIP) All adults 1 Td booster vaccination, followed by a boost of Td every 10 years, recommended for all adults who lack documentation of vaccination or have no evidence of previous infection. 1 dose recommended per pregnancy regardless of interval since prior vaccination. None* 9/23/2010
Varicella (ACIP) All adults 2 doses recommended for all nonpregnant adults who lack documentation of vaccination, or lack evidence of immunity or previous infection. None* 9/23/2010
Zoster (Shingles) (ACIP) Adults age 60+ 1 dose recommended for nonpregnant adults age 60+ who lack documentation of vaccination or have no evidence of previous infection. None* 9/23/2010

*The Federal FAQ Set 12 Q8 reinforces regulations that immunizations recommended by ACIP for routine use in adults must be covered without cost sharing.

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