Preventive Services Without Cost Sharing

New Private Health Plans Must Pay for Screenings and Other Preventive Services. Will the Benefits Outweigh the Costs?

Preventive services, such as vaccines and screenings, have the potential to help people live longer, avoid disease and disability and be healthier and more productive. The Affordable Care Act (ACA) expands coverage of preventive services both within private health insurance plans and within Medicare and Medicaid, so more people can benefit from these services.

As of September 23, 2010, the health reform law requires new private health insurance plans to fully cover the costs of 45 recommended preventive services. This means patients pay no deductibles or copayments or otherwise share costs of these services. As of January 1, 2011, the new law will also require coverage for a new annual wellness visit under Medicare and eliminates cost sharing for recommended preventive services covered by Medicare. Additionally, the new law gives state Medicaid programs financial incentives to cover preventive services for adults and supports initiatives to improve public understanding of the benefits of lifetime preventive services.

This Health Policy Brief examines the expansion of preventative services and the pros and cons of screenings and other tests that might increase costs without necessarily improving health outcomes, and was published online on December 28, 2010 in Health Affairs.