April 19, 2023 – The Departments of Labor, Health and Human Services, and the Treasury (Departments) recently issued frequently asked questions (FAQs) on the Affordable Care Act’s (ACA) preventive care coverage requirement. These FAQs result from a recent court decision in Texas (Braidwood Management Inc. v. Becerra) as the decision invalidates part of the ACA’s preventive care mandate.
Effects on Employer-sponsored Health Plans
As a result of the court decision, health plans are no longer required to cover preventive care items or services that have an “A” or “B” recommendation by the U.S. Preventive Services Task Force (USPSTF) on or after March 23, 2010. Despite this, the Departments encourage plans and issues to continue covering “A” and “B” items and services without cost sharing.
If an item or service was recommended with an “A” or “B” rating by the USPSTF prior to March 23, 2010, then health plans must continue to cover them without cost sharing. Notably, state laws regarding preventive care coverage requirements for insured health plans are not affected by the Braidwood decision.
It is important to note that the Biden administration has appealed the court’s decision to the 5th Circuit Court of Appeals and asked the 5th Circuit to put the ruling on hold pending the appeal. At this time, it is uncertain whether the ruling will be reversed or upheld.
If the ruling is upheld, plans and issuers must comply with applicable notice requirements when making changes to the terms of coverage regarding items and services recommended by the USPSTF.
As more information is made available, Creative Benefits, Inc. will release updates.