What are enhanced preventive care benefits?

The ACA includes many provisions directed at helping people receive preventive care services. Several of these include making certain preventive care services available with no cost-sharing, meaning without any co-payments, co-insurance, or deductibles, when services are received from in-network providers. Grandfathered plan designs are not required to implement these benefit enhancements, except for the elimination of annual dollar limits on preventive care.

Preventive services that include no member cost-sharing (through in-network providers) include routine physicals, screening for breast, colon and prostate cancer, routine immunizations, and tobacco cessation programs.

Women’s preventive care (through in-network providers) includes tubal ligation surgical sterilization, generic contraceptives, contraceptive devices, contraceptive counseling, certain breast pumps, lactation support, gestational diabetes and HPV screening, and screening and counseling for sexually transmitted disease, HIV screening and counseling, and domestic violence. In addition, some insurers like PacificSource also removed cost-sharing on vasectomies for men when received in an in-network office setting, although not required by the ACA.