Please provide your zip code to see plans in your area.
Since 2014, under the Affordable Care Act, all new individual and small-group health insurance policies (including those sold in the ACA’s health insurance exchanges and off-exchange) must cover essential health benefits for all enrollees.
And there cannot be annual or lifetime caps on the amount of money the insurer will pay for the services. (Note that there can still be a cap on the number of covered visits. For example, an insurer might cover 20 physical therapy visits in a year, and that’s still allowed.)
For the time being, no. But a federal judge has ruled against requiring USPSTF recommendations to be covered by health insurers. That case is still up in the air as of early 2023, and no final order has been issued. That’s expected in 2023, and the ruling is also expected to be appealed.
Yes, female contraception is part of the ACA’s preventive care essential health benefit. To be clear, contraception coverage is not specifically spelled out in the ACA as one of the essential health benefits. Instead, the law directed the Health Resources and Services Administration (HRSA) to define woman-specific services that must be covered under the preventive care EHB category. So HRSA developed those guidelines, and they include coverage for the full range of female contraceptives approved by the FDA.
However, the rules for employer exemptions from the contraceptive coverage mandate have changed over the years.
The Obama administration created an exemption for religious organizations, and an accommodation process by which women with coverage under exempt organizations could still access zero-cost contraception. The Trump administration expanded the exemption to also include organizations with moral objections, and made the accommodation optional for plan issuers with exemptions.
But the Biden administration has proposed a rule change in 2023 that would eliminate the moral objection exemption, and that would ensure a way for women to obtain zero-cost contraception, even if they’re enrolled in a plan that has a religious exemption from the contraception mandate.
The ACA outlined the essential health benefits as broad categories of care, and it’s up to each state to define exactly what has to be covered under each essential health benefit category. States do this by designating a benchmark health plan, (See definition 2 here.)
So although the ACA’s essential health benefit categories are the same in every state, the specifics of exactly what has to be covered by individual and small group health plans will vary from one state to another.
We can look at physical therapy – which is part of the habilitative/rehabilitative EHB – for a good example of how this works in a couple of states:
This is just one example of how “covered” doesn’t mean covered in the same way from one state to another. It all depends on the benchmark plan in your state, as well as state-specific benefits mandates that a state has implemented via the legislative process (for example, requiring all state-regulated health plans to cover male contraception, which goes beyond what the federal government requires in terms of contraceptive coverage).
Millions of Americans have coverage for the ACA’s essential health benefits, including:
Grandmothered and grandfathered plans are not required to cover the ACA’s essential health benefits, although grandmothered plans are required to cover recommended preventive care with no cost-sharing. Large group plans are also not required to cover essential health benefits (but if they do, they cannot impose dollar limits on the benefit), although they are required to cover recommended preventive care without any cost-sharing, unless they’re grandfathered.