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|
|Chlamydia and Gonorrhea Screening (USPSTF)||Sexually active women < 24 years, and older women at increased risk||Screening tests for chlamydia and gonorrhea.||None||9/23/2015|
|Contraceptive Services and Counseling (HRSA)||Women with reproductive capacity||All FDA-approved contraceptive methods, sterilization procedures, and patient education and counseling for all women with reproductive capacity, as prescribed by a health care provider.||Federal FAQs, Set 26 Q2-4: insurers must cover at least one of each of the 18 different contraceptive methods for women, as prescribed, as outlined in the FDA’s Birth Control Guide. Set 12, Q14-17: Education, counseling and services related to follow-up and management of contraception, and device removal are to be covered. Employers with religious or moral objections can receive exemptions or accommodations from covering contraceptives.||8/1/2012|
|HIV Infection Counseling and Screening (HRSA)||Sexually active women||Counseling and screening for HIV infection annually.||Federal FAQs, Set 12 Q9: counseling for HIV could occur as part of a well-woman visit. Federal FAQs, Set 12 Q13: “Screening” for HIV indicates a HIV test.||8/1/2012|
|HIV Infection Screening (USPSTF)||Adults age 15 – 65. Younger and older individuals at increased risk.||HIV infection screening. Adolescents < 15 and adults > 65 who are at increased risk should also be screened.||Federal FAQs, Set 12 Q13: “Screening” for HIV indicates a HIV test.||4/30/2014|
|STI Counseling (USPSTF)||Adults at increased risk; all sexually active women||Intensive behavioral counseling for all sexually active adolescents and for adults at increased risk for sexually transmitted infections (STIs).||Federal FAQs, Set 12 Q9: counseling for STI’s could occur as part of a well-woman visit.||9/23/2010|
|STI Counseling (HRSA)||Sexually active women||Counseling on sexually transmitted infections for all sexually active women, annually.||Federal FAQs, Set 12 Q9: counseling for STI’s could occur as part of a well-woman visit.||8/1/2012|
|Syphilis Screening (USPSTF)||Asymptomatic, non-pregnant adults and adolescents at increased risk, which include:
Other populations may be at higher risk including:
|Screening for syphilis infection.||The 2016 recommendation is similar to the 2004 version, but specifies that that men who have sex with men and people living with HIV may benefit from screening every 3 months which may be covered per clinician’s recommendation.||Coverage requirement for the 2016 recommendation takes effect for plan years beginning on/after June 30, 2017.
Current coverage policy for 2004 recommendation in place since 9/23/2010.