Is it true that Obamacare’s preventive care mandates only help women?

Many of the Affordable Care Act's preventive care mandates – including coverage of screenings – apply to both men and women. | Image: joyfotoliakid / stock.adobe.com

Q. I’ve heard that Obamacare’s preventive care mandates only help women. I’m a man, and I feel like I’m getting the short end of the stick.

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A: Never fear, the ACA mandates free preventive care for everyone. There are certain services that are specific to all adults, some for children, and a separate subset that apply to women. HHS has explained why there was a special need for mandated benefits that apply to women’s health – for the most part, it’s preventive care that applies to illnesses or conditions that only – or predominantly – impact women.

What preventive services are free?

“Free preventive care” is not a catch-all phrase. The service in question has to fall into one of three categories in order to be under the umbrella of preventive care that non-grandfathered plans must provide at no cost to the consumer (at the time of service; it’s understood that the cost of preventive care is wrapped into the premiums that we all pay each month):

Are any free preventive services specific to men?

A one-time abdominal aortic aneurysm screening for men age 65-75 who have ever smoked is a covered preventive service that only applies to men. But in general, the recommended preventive health care services for men also fall into the category of preventive health care for adults: Things like alcohol screening, blood pressure and cholesterol screening, colonoscopies, STI screening, and Type 2 Diabetes screening (for adults with hypertension) are all preventive services that apply to both men and women.

What about PSA screening, you might ask? Why is that not one of the adult preventive services covered at no cost by all plans? Well, because it’s actually not recommended at all past age 70, and has mixed reviews for younger men. The USPSTF gives it a grade of C for men age 55-69, and D for men age 70 or older, and “recommends against PSA-based screening for prostate cancer in men 70 years and older.”

There are lots of preventive care services that get ratings below a B on the USPSTF grading system. Unless they’re otherwise covered under the recommendations from HRSA or the CDC, they’re not considered recommended preventive care, and are thus not required to be covered by health insurance plans (note that insurers can cover them at no cost to the member, they just aren’t required to do so).

The contraception exception

Although most recommended preventive care for men is covered at no cost under the ACA’s preventive care guidelines, one exception is contraceptives. The Women’s Preventive Services Guidelines include all FDA-approved methods of contraception for women, which means that insurers have to cover at least one type of each method at no cost to the member. But there is no requirement that insurers pay for FDA-approved contraceptives for men.

Virtually all of the FDA-approved methods of contraception apply to women — the only exceptions are condoms and vasectomies. Female condoms are covered under the ACA’s preventive care rules if they’re prescribed by a doctor. Insurers do not have to cover male condoms, but those are generally purchased over the counter anyway, without a prescription.

But vasectomies can be expensive, and are obviously not available in a drugstore. Although female sterilization (which costs a lot more than a vasectomy) is covered in full on non-grandfathered health plans, the same is not true for male sterilization. Some health plans do cover all or part of the cost of a vasectomy, but they are not required to do so. Some states have enacted laws requiring state-regulated health plans to fully cover the cost of vasectomies, but state laws do not apply to self-insured health plans, which account for the majority of employer-sponsored health plans.

While mandated contraceptive and maternity coverage under the ACA are specific to women, there is no doubt that they are beneficial to both men and women, since babies – and unintended pregnancies – have fathers.


Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

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Hannahrobera

This is not a good answer. For starters, you have not listed the number of things that women only get. The long list of preventatve services or pregnancy services. Note that men are hugely subsidising this also as they pay the same premiumum as women as ACA made it illegal to charge different rates based on gender (of course men still pay more for car insurance as this was not changed)

The preventive care guidelines are centered around evidence-based medicine. A large number of the woman-only preventive care mandates are related to pregnancy, and the rest are for conditions that also only apply to women. As noted in the article, if there are recommended preventive care services that only apply to men, those are covered as well. Even though pregnancy only affects women, every pregnancy also requires a man’s participation. So it never made sense to have those costs apply only to women’s health insurance premiums. Younger women have higher health care claims than younger men (due mostly to claims related… Read more »

Mark Noonan

So Why Exclude Vasectomies? It’s wrong and discriminatory to leave men at the hands of greedy Insurance Companies. You have no idea how angry this makes me. Why she she get tubal ligation free while I have to pay an arm and leg for vasectomy. Sometimes Medical based is wrong. It’s cheaper to cover vasectomy anyway.