Private Health Plans Must Cover Women’s Obesity Counseling, Other Preventive Services
By Emma Freer

Starting next year, private health plan policies that began after the Affordable Care Act (ACA) went into effect now will have to cover multiple types of prevention counseling for women, as well as contraceptive care, double electric breast pumps, and more.

The federal government recently updated its women’s preventive services guidelines under ACA, which determine the women’s preventive services that “nongrandfathered” private plans must cover without cost sharing. The update adds one new service related to obesity prevention and revises five existing services, including one related to breastfeeding services and supplies.

The U.S. Department of Health and Human Services (HHS) established the guidelines in 2011. Since then, the agency has appointed the American College of Obstetricians and Gynecologists (ACOG) to convene clinician-, academic-, and consumer-focused health professional organizations to recommend updates, which are then considered by the Health Resources & Services Administration (HRSA). Most private group health plans must cover the preventive services listed in the guidelines without a copayment, coinsurance, deductible, or other cost sharing.

In late December 2021, HRSA approved a series of updates. Beginning in 2023, private health plans subject to the regulations will be required to fully cover the following services:

  • Obesity prevention counseling for women aged 40 to 60 with normal or overweight body mass index;
  • Double electric breast pumps and breast milk storage supplies;
  • Contraceptive care, including male condoms;
  • Behavioral counseling by health care clinicians for women at increased risk for sexually transmitted infections;
  • HIV risk assessment and prevention education beginning at age 13 and continuing as determined by risk; and
  • Well-woman preventive visits completed at a single visit or as part of a series of visits that take place over time, including prepregnancy, prenatal, postpartum, and interpregnancy visits.

Medicaid programs are not subject to the updated guidance, although the recommendations often serve as the basis for updates to Medicaid benefits. Some of the changes, including full coverage of double electric breast pumps and contraceptive care, already are Texas Medicaid benefits.

Kimberly D. Gregory, MD, chair of the ACOG advisory panel that makes recommendations to HHS, said in a Jan. 11 statement that these changes will “help to advance our ongoing work toward equity by making preventive services … more accessible to all through coverage without cost sharing.”

Last Updated On

April 05, 2022

Originally Published On

February 02, 2022

Related Content

ACA | Obesity | Womens Health

Emma Freer

Associate Editor

(512) 370-1383

Emma Freer is a reporter for Texas Medicine. She previously worked in local news, covering city politics, economic development, and public health. A native Clevelander, she graduated from Columbia Journalism School and the University of St. Andrews.

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