FACT SHEET
Staying Healthy without Copays
APRIL 2012
The Affordable Care Act (ACA) makes it easier for women and families to stay healthy and
avoid high health care bills down the road by requiring health insurers to cover preventive
services without any cost-sharing (e.g. deductibles, copays, and co-insurance).
This means that critical preventive services that women and families need to stay healthy
will be more affordable. And down the road, it means that everyone will save money because
the nation will be investing in preventing diseases and conditions, rather than treating them.
Why Is This Important?
Before the ACA was enacted, women and children
across the country often did not access the
preventive care they needed to stay healthy
because of financial concerns.
 More than half of women report having
delayed health care because of cost.
 Women disproportionately forego seeing
doctors, or getting recommended medical
tests, and are also more likely to skip tests
and screenings because of associated costs.1
“In 2011, an estimated 20.4 million
women and 14.1 million children
with private insurance received at
least one new preventive service at
no additional cost because of the
ACA”
— Benjamin D. Sommers and Lee Wilson,
ASPE Issue Brief
 Even modest cost-sharing presents a barrier
to necessary care for lower-income women and families.2
In 2011, an estimated 20.4 million women and 14.1 million children with private insurance
received at least one new preventive service at no additional cost because of the ACA.3
 Removing cost-sharing for key preventive services will help ensure everyone can access
the care they need to stay healthy.
 Allowing women and families to access important preventive services that they need
will benefit everyone.
 Over the long term, a healthier population can help reduce national health care
spending and increase workforce productivity.
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What Is Covered Without Cost-Sharing?
A comprehensive set of preventive services recommended by medical experts, including:
 For women…

Annual mammograms and screenings for osteoporosis;

Yearly well-women preventive care visits including preconception and prenatal
care;

All FDA-approved forms of contraception, including birth control pills,
implantable and injectable contraceptives, intrauterine devices (IUDs), and
sterilization;

The HPV vaccine for adolescent girls and young women, as well as cervical cancer
screenings, pap smears, and HPV testing for women age 30 and over; and

Screening and counseling for interpersonal and domestic violence.
 For families…

Prenatal and post-partum care services, including screening for gestational
diabetes and breastfeeding support, supplies, and counseling;

Well-baby doctor visits (every few months) and well-child doctor visits (once a
year) that include a comprehensive array of preventive services, including
physical exams, developmental assessments, and oral and hearing screenings;
and

Immunizations, including vaccinations and boosters against measles, mumps,
and rubella (MMR); diphtheria, tetanus, and pertussis (DTaP); and polio.
 For all adults…

Cardiovascular screenings including cholesterol tests to stop heart disease;

Diabetes screening;

Obesity screening and counseling to promote
healthy weight loss;

Colon cancer screenings for adults over age
50;

Tobacco and alcohol screening and cessation
interventions, such as counseling or
medication; and

Vaccines including flu, hepatitis, and
pneumonia.
Under the ACA, women are
guaranteed access to preventive
services such as birth control,
mammograms, and cervical cancer
screenings, without cost-sharing.
For a full list of preventive services that must be covered without cost-sharing, see:
http://www.healthcare.gov/law/resources/regulations/prevention/recommendations.html.
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Who Qualifies?
For women with private health insurance, all new plans – whether purchased on the
individual market or sponsored by employers – must provide the recommended
preventive services without cost-sharing.
 The only plans that are exempt are “grandfathered” plans.


These plans existed prior to passage of
the ACA and are exempt from certain
requirements so long as they do not
make major changes, such as raising
cost-sharing requirements or reducing
benefits.
Over time, most plans are expected to
cease to have grandfathered status as
they make adjustments.4
This important new protection
applies broadly to ensure women
and families can access preventive
services regardless of where they
get their insurance coverage.
 Churches and other houses of worship that sponsor health plans for their employees
are exempt from the requirement to provide contraceptive coverage, however they
must provide all other recommended preventive services at no added cost.
 Certain health plans sponsored by religiously-affiliated organizations – such as
religious charities, hospitals, and universities – will not have to provide coverage for
contraception until 2013 when such coverage will be made available directly to
beneficiaries at no cost.
Women covered by Medicare will also have access to a range of preventive services
without cost-sharing.
 Medicare eliminated the Part B deductible and coinsurance requirements for many
preventive services, as well.5 Medicare beneficiaries also can receive an Annual
Wellness Visit at no cost to work with their provider to develop a personalized
prevention plan.
 Beginning in January 2013, states will receive increased federal financial assistance if
they remove cost-sharing requirements for recommended preventive services under
their Medicaid programs.
When Does This Protection Start?
New private health plans and Medicare are already required to cover most of the
recommended preventive services without cost-sharing.
 The requirements to cover certain women’s preventive services, including contraception,
will go into effect beginning on or after August 1, 2012 unless a religious exemption or
delay applies.
For more information, contact Kirsten Sloan, Vice President, at 202.986.2600 or
[email protected].
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1 Rustgi, S. D., Doty, M. M., & Collins, S. R. (2009, May 11). Women at Risk: Why Many Women Are Forgoing Needed Health Care. The Commonwealth Fund Publication.
Retrieved on February 17, 2011, from http://www.commonwealthfund.org/Content/Publications/Issue-Briefs/2009/May/Women-at-Risk.aspx
2 http://www.cbpp.org/cms/index.cfm?fa=archivePage&id=5-31-05health2.htm
3 http://aspe.hhs.gov/health/reports/2012/PreventiveServices/ib.pdf
4 Grandfathered plans are required to disclose their grandfathered status to enrollees in any materials describing benefits. If unsure of their plan’s status, women should check
with their insurance carrier or employer.
5 The complete list of preventives services available without cost-sharing under Medicare is available here: http://www.cms.gov/apps/files/MedicareReport2011.pdf.
The National Partnership for Women & Families is a nonprofit, nonpartisan advocacy group dedicated to promoting fairness in the workplace, access to quality health care and
policies that help women and men meet the dual demands of work and family. More information is available at www.NationalPartnership.org.
© 2012 National Partnership for Women & Families. All rights reserved.
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