The provision of the Affordable Care Act (ACA) that requires most private health plans to cover many preventive services without any cost-sharing for their enrollees is being challenged in federal court. The U.S. District Court in the Northern District of Texas in September concluded that aspects of the requirement were unconstitutional and violated religious rights but has allowed the provision to remain in effect while it considers a remedy.
As the courts consider the ACA’s preventive services requirement, a new KFF analysis finds that roughly 100 million people received ACA-required preventive services with no patient cost-sharing in a typical year.
Overall, about 60% of the 173 million people enrolled in private health coverage used at least one of the ACA’s no-cost preventive services in 2018 prior to the COVID-19 pandemic.
The most commonly received preventive services include vaccinations, well woman and well child visits, and screenings for heart disease, cervical cancer, diabetes, and breast cancer. COVID-19 vaccines are also provided at no cost to patients under the ACA’s preventive services requirement, though how many people will take them up in the future is uncertain.
Women and children are more likely than men to have used at least one no-cost preventive service through their private insurance in 2018.
“Preventive Services Use Among People with Private Insurance Coverage” also looks at variations in the use of preventive services in the large group, small group and individual markets. It is available through the Peterson-KFF Health System Tracker, an online information hub that monitors and assesses the performance of the U.S. health system.
In addition, other KFF resources explain the Braidwood Management Inc. v. Becerra case and its implications:
Learn about the implications of the most recent legal challenge contesting the ACA requirement that most private insurance plans cover specific preventive care items and services at no cost to patients.
Answer key questions about pre-exposure prophylaxis (PrEP) and its coverage, which prompted the court challenge.
Review findings on women’s receipt of cancer screenings and other preventive services as well as knowledge of insurance coverage requirements for these services.
Read a summary of the federal requirements for coverage for preventive services in private plans, major updates to the requirement, and recent policy activities.
Explore the adult preventive services most private plans must cover, including a summary of the recommendation, the target population, and related federal coverage clarifications.