QUESTION

I know recommended preventive services are updated all the time. Must my insurance cover newly recommended preventive services without cost sharing?

Post enrollment issues | Individual Health Insurance |
ANSWER

If you are enrolled in an Affordable Care Act plan, then yes, your plan must cover the newly recommended preventive service. For example, this year, the federal government has expanded the preventive services guidelines to include anxiety
and depression screenings. However, your plan doesn't have to cover most newly recommended services right away. New or updated recommendations must be covered without cost-sharing at the start of the plan year beginning on or after one year from the date the recommendation was issued. For instance, if a recommendation is issued during the plan year, your insurer does not have to make changes to cover the service mid-year, unless an expert body recommending the change has determined that a service is harmful or poses safety concerns. One exception to this is updates to the COVID-19 vaccine. Health plans and insurers must cover and waive cost-sharing for those immediately upon FDA authorization or approval. (26 C.F.R § 54.9815-2713(a)(1); FAQs about Families First Coronavirus Response Act, Coronavirus Aid, Relief, and Economic Security Act, and Health Insurance Portability and Accountability Act Implementation Part 58 (Mar. 29, 2023)).

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