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Do 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 /

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

Do Obamacare’s preventive care mandates only help women?

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.

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 health insurance 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):

KFF’s preventive services tracker includes a note for each service, clarifying which body recommends it. That’s important in terms of the lawsuit over covered preventive care, which we’ll discuss in a moment.

In normal circumstances, there’s a delay that can last nearly two years before recommendations from USPSTF, HRSA, or ACIP are built into health insurance plans. But for COVID-19 vaccines, that was shortened to just 15 business days. ACIP finalized their recommendation for the COVID-19 vaccine in mid-December 2020, so all non-grandfathered health plans cover COVID-19 vaccines with zero-cost sharing as of early January 2021 (which was well before the vaccines were actually available for most people).

Has a judge ruled that health plans will no longer cover preventive care?

In September 2022, Judge Reed O’Connor issued a ruling in Braidwood v. Becerra that potentially threatens the ongoing coverage of services recommended by the USPSTF. But for the time being, nothing has changed. The judge has asked the parties in the lawsuit to submit additional information and we do not yet know the scope of the eventual ruling (whether it will apply only to the plaintiffs, or potentially nationwide) or whether it will be stayed (not go into effect) while the case is appealed.

Judge O’Connor ruled that requiring health plans to cover services recommended by the USPSTF violates the Appointments Clause, because members of the USPSTF have not been nominated by the president or confirmed by the Senate (this is by design; Congress intended this body to be comprised of experts who are free from political interference).

He also ruled that requiring health plans to cover PrEP (for prevention of HIV transmission) is a violation of the Religious Freedom Restoration Act (PrEP has an “A” rating from the USPSTF, so if USPSTF recommendations were to be eliminated from health plan coverage requirements, that would effectively remove the requirement to cover PrEP).

Judge O’Connor did not rule against ACIP and HRSA having authority to recommend preventive care requirements for health plans. So if his ruling were to eventually be upheld by a higher court, it would potentially mean that some currently-covered preventive services would become optional for health plans to cover with zero cost-sharing, while others would not (here’s a list of which services are recommended by each entity).

For health plans that are regulated at the state level (ie, plans that aren’t self-insured), states could require health plans to continue to cover USPSTF-recommended care with no cost-sharing, even if that requirement is eliminated at the federal level. States could ensure this is part of their benchmark plan, which would apply to individual and small group plans, or could impose legislation that applies to all state-regulated plans, including large group plans.

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 (note that this is covered because it gets a “B” rating from the USPSTF; if Judge O’Connor’s ruling in Braidwood v. Becerra were to eventually be upheld and put into effect, it’s possible that health plans could stop covering this).

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 — and again, these are covered because the USPSTF recommends them.

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).

One note about preventive screening coverage: A screening is only required to be covered with zero cost-sharing if it’s truly just a screening test, following the recommended screening guidelines in terms of age and frequency. If a test is done because of a medical concern, or conducted more frequently than the normal recommended schedule based on a person’s medical history, the health plan’s regular deductible and coinsurance can apply.

So for example, a routine mammogram would be free, whereas a mammogram done to check out a lump that the patient or doctor discovered would not be free. The same holds true for colonoscopies: Starting at age 45, a routine colonoscopy every ten years is recommended, and these are covered in full by non-grandfathered health plans — and note that the health plan still has to cover the screening colonoscopy with zero cost-sharing even if polyps are discovered and removed during the procedure (see Question 5 in this CMS guidance). But if a person has colonoscopies before age 45 or more frequently due to family history or symptoms, the health plan can apply regular cost-sharing requirements.

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) has to be covered in full by 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 Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

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2 years ago

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)

Louise Norris
Louise Norris
2 years ago
Reply to  Hannahrobera

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 to pregnancy, which really need to be equally borne by men and women, despite the fact that it’s the woman’s body that carries the fetus), but older men have higher health care costs than older women. Pre-ACA, insurers often accounted for this by charging higher premiums for men once they were older (50-55 was a common threshold for this). The ACA banned gender-based pricing altogether, meaning that older men no longer pay more than older women for health insurance, just as younger women no longer pay more than younger men.
It’s really only young men that pay more for automobile insurance, and some states have taken action to ban gender rating on auto insurance plans:'s%20a%20widespread%20belief%20that,other%20rating%20criteria%20being%20equal.

Mark Noonan
Mark Noonan
2 years ago
Reply to  Louise Norris

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.

Noonan Mark
Noonan Mark
1 year ago
Reply to  Louise Norris

BS Answer. Vasectomies should be covered. And exclusion of men Andy harms women in the long run putting the burden of birth control on women.

Louise Norris
1 year ago
Reply to  Noonan Mark

I would love to see preventive coverage mandates expanded to include vasectomies. Several states have implemented that mandate for state-regulated plans, and I hope that more will follow suit.

1 year ago

That is just cherry picking. Men’s health is worse than women by any mesurable stats. They drunk more, they use alcohol more, they work in dangerous workplaces more, they die younger, they are the majority of non gendered cancers patients, they are more likely to have conditions like ADHD or Autism, more likely to be rough sleepers, suicide, work at night, overwork, etc. But there si no men’s health plan by the government. There is initiative or funds specially aimed at men. But there hundreds of thing for women and most of it is not for pregnancy or related things. The world just care about women more than even though men are the ones who are the ones who die for the country for the country and pay the majority of taxes.

Last edited 1 year ago by Paul
Noonan Mark
Noonan Mark
1 year ago

BS Answer. It’s sexist and discriminatory.

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