The Health Resources and Service Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) approved updated preventive services guidelines for women on December 20, 2024. Under the Affordable Care Act (ACA), group health plans and insurers, with the exception of non-grandfathered plans[1], must cover certain preventive health services without cost-sharing.
The updated HRSA guidelines apply to plan years beginning on or after December 20, 2025. Under the updated guidelines, plans generally must cover the following preventive services without cost-sharing:
- Screening for Anxiety – Adolescent and adult women can undergo screening for anxiety, including pregnant or postpartum women.
- Screening and Counseling for Interpersonal Partner and Domestic Violence – Adolescent and adult women are entitled to an annual screening for intimate partner and domestic violence. If needed, the women also are entitled to intervention services such as counseling, education, and other supportive services.
- Breast Cancer Screening for Women of Average Risk – Women are eligible for an annual or biennial mammography screening when they turn age 40, but no later than age 50, and continuing through age 74. Services without cost-sharing also are available for additional imaging, if needed, to complete the screening process or address any findings. Additional imaging may include magnetic resonance imaging (MRI), ultrasound, and pathology evaluation.
- Breastfeeding Services and Supplies – Comprehensive lactation support services are available during the antenatal, perinatal, and the postpartum period to ensure successful breastfeeding. These support services may include counseling, education, and breastfeeding equipment and supplies.
- Patient Navigation Services for Breast and Cervical Cancer Screening –Women are entitled to individualized navigation services for breast and cervical cancer screening. Navigation services include, but are not limited to, assessment and planning, access and navigation of health care systems, referrals to appropriate support services, such as language translation, transportation, and social services, and patient education.
- Screening for Gestational Diabetes Mellitus and Diabetes after Pregnancy – Women can access screening for gestational diabetes mellitus (GDM) after 24 weeks of pregnancy to prevent adverse birth outcomes. Women with a history of GDM can access screening within one year postpartum and every three years for a minimum of ten years post-pregnancy.
- Screening for Human Immunodeficiency Virus Infection (HIV) – Testing is available at least annually for adolescents and women.
- Screening for Cervical Cancer – Average-risk women ages 21 to 65 can undergo screening every three years.
- Screening for Urinary Incontinence – Annual screening for urinary incontinence is available annually.
- Counseling for Sexually Transmitted Infections – Counseling for sexually active adolescents and women at an increased risk for sexually transmitted infections are entitled to behavioral counseling.
- Well-Woman Preventive Visits – Women are eligible for at least one well-woman preventive visit per year, beginning in adolescence.
- Contraception – Women have access to the full spectrum of female-controlled contraceptives, as approved by the U.S. Food and Drug Administration (FDA), to prevent unintended pregnancy. [2]
Preventive services that plans must cover without cost-sharing include those specified by HRSA, the United States Preventive Services Task Force (USPSTF), and the Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices (ACIP). However, litigation remains over whether HRSA, USPSTF, and ACIP have the authority to determine what preventive services plans must cover without cost-sharing. To date, only the recommendations of USPSTF are affected, and only as to the parties to the pending litigation. However, the U.S. Supreme Court now has granted a petition for certiorari in the case, so plans must closely monitor the litigation and any pending changes that result.
HBL has experience in all areas of benefits and employment law, offering a comprehensive solution to all your business benefits and HR/employment needs. We help ensure you are in compliance with the complex requirements of ERISA and the IRS code, as well as those laws that impact you and your employees. Together, we reduce your exposure to potential legal or financial penalties. Learn more by calling 470-571-1007.
[1] Non-grandfathered plans and coverage (generally, plans or policies created or sold after March 23, 2010, or older plans or policies that have been changed in certain ways since that date.
[2] Plans maintained by organizations objecting on religious beliefs or moral convictions are exempt.
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