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|
|Bacteriurea Screening (USPSTF)||Pregnant women||Bacteriuria screening for pregnant women at 12 to 16 weeks gestation or at first prenatal visit, if later.||None||9/23/2010|
|Breastfeeding Counseling (USPSTF)||Pregnant and postpartum women||Interventions during pregnancy and after birth to promote and support breastfeeding.||Federal FAQs, Set 12, Q18: USPSTF recommendations on breastfeeding apply to interventions during pregnancy, while HRSA guidelines specifically “incorporate comprehensive prenatal and postnatal lactation support, counseling, and equipment rental”, which must be covered without cost sharing.||9/23/2010|
|Breastfeeding Support, Supplies, and Counseling (HRSA)||Pregnant and postpartum women||Lactation counseling by a trained provider during pregnancy and/or postpartum, and rental of breastfeeding equipment for each birth.||Federal FAQs, Set 12, Q18-20: coverage for lactation support, counseling, and costs of renting or purchasing breastfeeding equipment extends for the duration of breastfeeding.||8/1/2012|
|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.|
|Folic Acid Supplements to Prevent Neural Tube Defects (USPSTF)||Women planning or capable of pregnancy||Daily supplement containing 0.4 to 0.8 mg of folic acid.||None||9/23/2010|
|Gestational Diabetes Screening (HRSA)||Pregnant women||Gestational diabetes screening in pregnant women between 24 and 28 weeks of gestation and at the first prenatal visit for pregnant women identified to be at high risk for diabetes.||None||8/1/2012|
|Gestational Diabetes Screening (USPSTF)||Pregnant women||Gestational diabetes screening in asymptomatic pregnant women after 24 weeks of gestation.||None||1/31/2015|
|Hepatitis B Screening (USPSTF)||Pregnant women||Screening for hepatitis B virus (HBV) infection in pregnant women at their first prenatal visit.||None||9/23/2010|
|HIV Infection Screening (USPSTF)||Pregnant women||HIV screening for all pregnant women, including those in labor who are untested or with unknown HIV status.||Federal FAQs, Set 12 Q13: screening for HIV indicates a HIV test.||4/30/2014|
|Preeclampsia Preventive Medicine (USPSTF)||Pregnant women at increased risk||Use of low-dose aspirin (81 mg/d) as preventive medication after 12 weeks of gestation in women who are at high risk for preeclampsia.||None||9/30/2015|
|Syphilis Screening (USPSTF)||Pregnant women||Screening for syphilis infection.||None||9/23/2010|
|Tobacco Smoking Cessation: Behavioral Interventions (USPSTF)||Pregnant women who smoke||Discussion with clinicians on tobacco use and cessation, and behavioral interventions for cessation to pregnant women who use tobacco products.||Federal FAQs, 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|