New Health Insurance Plans Required to Provide Free Preventive Health Care

New federal regulations were issued that will guarantee affordable preventive care services for millions of Americans.  The new interim final regulations specify that new health insurance policies beginning on or after September 23, 2010, must include preventive services recommended by the U.S. Preventive Services Task Force, as well as preventive services recommended by the Advisory Committee on Immunization Practices in their coverage plans.  In addition, health plans will be prohibited from charging co-payments, co-insurance or deductibles for these services when they are delivered by network providers.

These new rules supplement other provisions in the Affordable Care Act that support prevention, such as the creation of a National Prevention and Health Promotion Strategy and a Prevention and Public Health Fund to invest in prevention initiatives.  Another policy in the federal law will increase the number of primary care professionals in order to increase access to preventive services.  The elimination of cost-sharing for preventive care will make it easier and more affordable for Medicare and Medicaid enrollees to access critical preventive screenings and services.

Plans covered by these rules must offer coverage of a comprehensive range of preventive services that are recommended by physicians and other experts.  The covered services will include: mammograms, colonoscopies, immunizations as well as screenings for diabetes, high cholesterol, high blood pressure, breast cancer, depression, HIV and obesity.  Children would qualify for more than two dozen services, including vaccinations for influenza, diphtheria and tetanus and screenings for autism, hearing and vision impairments.  A full list of the covered services is available at

It is estimated that by next year, 41 million people in employer and individual plans will benefit from the new prevention provisions under the Affordable Care Act.  By 2013, the total number of Americans who will benefit from the improved prevention coverage will increase to 88 million.

These rules will not apply to grandfathered health plans, which are group or individual plans that existed at the time the federal law was enacted and are therefore not subject to a large majority of the new insurance reforms.  However, HHS officials expect the number of grandfathered plans to decrease over time.

Resources: - Background: The Affordable Care Act's New Rules on Preventive Care - Implementation Center - Press Release - Administration Announces Regulations Requiring New Health Insurance Plans to Provide Free Preventive Care
LA Times - New Healthcare Rules Issued for Preventive Services