Maintain coverage of preventive services without cost-sharing
PAN’S POSITION:
Protect and maintain access to clinical preventative services without cost-sharing through private insurance.
The Affordable Care Act (ACA) preventive services coverage policy has become an established part of health coverage for most people in the United States. Millions of individuals have benefitted from increased access to care and coverage of clinical preventive services without cost-sharing. Congress and the administration should protect and maintain this access.
Section 2713 of the ACA requires private insurance plans to cover recommended preventive services without any patient cost-sharing such as copayments, deductibles, or coinsurance. Prior to the ACA, research showed that cost-sharing, even in small amounts, reduced the likelihood that people would use preventive services. Millions of people each year reported delaying or forgoing needed healthcare due to costs.
The ACA requires private plans to cover four broad categories of services for adults and children:
- Evidence-based screenings and counseling
- Routine immunizations
- Preventive services for women
- Preventive services for children and youth
In addition, individual and small group plans in the health insurance marketplaces, also known as exchanges, are required to cover an essential health benefit (EHB) package that includes a full range of preventive services.
A report from the U.S. Department of Health and Human Services Assistant Secretary for Planning and Evaluation (ASPE) estimates that in 2020, about 151.6 million people were enrolled in private health insurance plans that cover preventive services with no cost-sharing. The report also noted that studies examining the impact of the ACA showed increased use of preventive services, specifically colon cancer screening, vaccinations, use of contraception, and chronic disease screening.
Congress and the administration should block efforts to undermine the coverage of these preventative services through the addition of cost-sharing or removal of benefits.