Health insurers urged to continue covering preventive services without cost-sharing

Health insurers urged to continue covering preventive services without cost-sharing

April 4, 2023

OLYMPIA, Wash. — Insurance Commissioner Mike Kreidler has sent a letter to Washington health insurers in response to last week’s U.S. District Court ruling on some of the Affordable Care Act’s preventive care benefits, asking them to continue critical coverage of all recommended preventive services that individuals and families have supported since 2010.

“I have asked health plans doing business in Washington to continue to cover all preventive services without cost-sharing for patients,” Kreidler said. “Millions of people rely on this benefit to get affordable coverage for the early detection and prevention of serious medical conditions. After 13 years, this coverage has saved lives here in Washington and across the country.”

Kreidler’s office is also considering all options including legislative solutions.

Last Thursday, a U.S. District Court judge in the Northern District of Texas issued a ruling that overturned some of the Affordable Care Act’s most popular preventive care benefits. The plaintiffs argued in Braidwood Management v. Becerra that some of the preventive services they were required to cover without cost sharing were unconstitutional and violated their religious rights under federal law.

The ACA requires all health plans to cover preventive services recommended by three different organizations without cost-sharing:

US Preventive Services Task Force Advisory Committee on Immunization Practices Health Resources and Services Administration, based on recommendations from the Women’s Preventive Services Initiative and the Bright Futures Program

This decision applies to all preventive services recommended by the US Preventive Services Task Force (USPSTF) since March 2010 when the ACA went into effect. It also applies to any changes to previously recommended preventive services. It specifically includes pre-exposure prophylaxis (PrEP), a medication taken to prevent HIV.

In 2018, the Washington state legislature enshrined several key benefits of the ACA into state law. The law requires that beginning in 2018, state-regulated health plans must at least provide coverage for the same preventive services required by the ACA as in effect on December 31, 2016. These services must be covered without cost-sharing.

Recommendations made after 2016 may now be subject to cost-sharing, including anxiety screening for children and youth, depression screening for pregnant and postpartum women, and colorectal cancer screening for adults aged 45-49 years old.

The Biden administration is expected to appeal the decision.

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