Health Care Reform: Additional ACA Guidance on Preventative Care Coverage Released


Today federal regulators released additional guidance on the Affordable Care Act’s preventative care requirements for non-grandfathered plans, including additional information on contraceptive coverage.

According to the new guidance, non-grandfathered plans must cover all FDA-approved contraceptives prescribed by the member’s provider without cost-sharing not just oral contraceptives. The guidance also provides that consistent with past guidance a plan may use reasonable medical management techniques to control costs. For example, a plan could cover generic contraceptives at 100% but imposing cost sharing on equivalent brand names. However, the plan must have a process for waiving the cost-sharing if the generic drug would be medically inappropriate as determined by the member’s provider.

The new guidance also provides information on other preventative care issues, including well-woman visits, breastfeeding counseling, domestic violence screening and polyp removals performed during colonoscopies.

A copy of the guidance can be accessed at

DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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