HHS: Private insurers get clarity on preventative care coverage


The Health and Human Services Department on Tuesday clarified what private insurers must cover under preventative care guidelines for women, including screenings and counseling without co-pays or deductibles for 2023 plans.

The Health Resources and Services Administration guidance is meant to help clinicians decide which preventive services to offer patients. The Affordable Care Act also requires insurers to cover the recommended services without cost-sharing.

“These updated guidelines help ensure that we’re providing critical services to keep families healthy, based on the latest science and data available. The Biden-Harris administration will continue to build on the Affordable Care Act to make preventive care available to as many Americans as possible nationwide,” HHS Secretary Xavier Becerra said in a statement.

Here are 6 things addressed in the guidelines.

1. Electric pumps for breastfeeding parents should be a priority and not contingent on prior failure of manual pumps, the guidance says. The guidelines also call for lactation support services before and after pregnancy.

2. For the first time, HRSA said clinicians will need to offer counseling for overweight or typically-weighted women aged 40 to 60, to help them understand how to prevent obesity.

3. The agency revised its guidelines on preventative well visit coverage, saying they can take place once a year or over time to make sure all necessary services are delivered.

4. HRSA emphasized that contraceptive care includes screening, education, counseling and the actual provision of contraceptives. The new guidance no longer includes surgical sterilization via implant as one of the approved contraception methods, though it notes that the included list of approved methods is not exhaustive.

5. Additionally, HRSA changed HIV screening guidelines to say women over age 15 should be tested for the virus at least once in their life, and to recommend risk assessment and prevention education begin at age 13 and continue depending on the patient’s risk level.

6. A separate HRSA guidance, also released Tuesday, added universal suicide screening risk to the current depression screening policy for adolescents age 12 to 21, along with new screening categories for sudden cardiac arrest and hepatitis B infection risk assessment in pediatric patients.



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