An important and often overlooked benefit of the Affordable Care Act (ACA) is full coverage and benefits for preventive care. Specifically, the ACA established that virtually all private health plans must provide 100% coverage (i.e., no cost share) for a host of preventive healthcare services. The only exception to this requirement are so called “grandfathered” plans, which are becoming more scarce every year. So in short, all non-grandfathered health insurance plans (i.e., individual, small group, large group, fully insured, and partially self-insured) may not require cost-sharing such as copays, deductibles, or coinsurance, for any of the listed preventive services, within the following broad categories:
The list of covered preventive services has grown considerably since this aspect of the ACA went into effect for non-grandfathered plans beginning/renewing on or after September 23, 2010. In 2012, specific “Women’s Preventive Services” were added, including some contraception drugs and devices. Initially, some 38 specific preventive services were indicated on the list, and as recently as 2014, there were 63 distinct preventive services included. Currently (2016/2017) there are 72.
Starting in late 2017/early 2018, the list of required covered preventive services increases to 98, and includes coverage for cholesterol screening and some statin drugs. So as health insurance plans begin renewing, and preventive care services grids are updated, expect to see certain statin drugs like Atorvastatin, Lovastatin, Simvastatin, and Pravastatin covered at a $0 cost-share, as early as the end of 2017! The actual drug(s) and dosages covered without a cost-share will vary depending on the insurance company and coverage.
IMPORTANT: All insurance companies and plans provide a detailed grid outlining the covered preventive services for the particular plan year. These grids can typically be found on employer, administrator, and/or insurance company web portals.
To access a comprehensive list of all covered preventive services by type, gender, frequency, click – https://www.uspreventiveservicestaskforce.org/BrowseRec/Index/browse-recommendations