Health Plans to Continue Providing Free Preventative Care

Health Plans to Continue Providing Free Preventative Care

On June 21, 2024, the 5th U.S. Circuit Court of Appeals ruled that part of the Affordable Care Act (ACA) which requires certain preventive health services to be covered without cost, is unconstitutional. However, this ruling applies only to the plaintiffs in the case and a small group of individuals and businesses in Texas. At this time, health plans and insurance issuers must continue to cover these preventive health services.

The services affected include screenings for various cancers, medications for chronic conditions, and mental health screenings, among others.

The case is expected to go to the U.S. Supreme Court for review.

ACA’s Preventive Care Mandate

The ACA requires non-grandfathered health plans to cover recommended preventive services without charging deductibles, copayments, or coinsurance if in-network providers issue the services. These services include:

  • Evidence-based items or services with an A or B rating in recommendations of the U.S. Preventative Service Task Force (USPSTF);
  • Immunizations for routine use in children adolescents and adults recommended by the Advisory Committee on Immunized Practices (ACIP);
  • Evidence-informed preventative care and screenings in guidelines supported by the Health Resources and Services Administration (HRSA) for infants, children, and adolescents; and
  • Other evidence-informed preventative care and screenings in HRSA-supported guidelines for women.

Impact of Decision

Health plans must still cover the full range of recommended preventive services without cost-sharing, except for the plaintiffs in the case. The future of the ACA’s preventive care mandate remains uncertain as the legal process continues to develop. Employers should stay informed as is it likely that the decision will be appealed to the U.S. Supreme Court.

Creative Benefits will continue to provide updates as they are made available. If you have questions regarding preventative care, contact your dedicated Creative Benefits, Inc. team member.