Preventive Services Coverage Update for Non-Grandfathered Plans

Under the Patient Protection and Affordable Care Act, non-grandfathered plans are required to provide certain preventive services without cost sharing. A recent decision issued by the United States District Court for the Northern District of Texas in Braidwood Mgmt. Inc. v. Becerra, vacated a portion of the preventive services mandate, including actions taken by the DOL, the HHS and the IRS, to implement or enforce the preventive services mandate after March 23, 2010. The Department of Justice filed a notice of appeal on March 31, 2023 and a motion to stay the District Court’s judgment on April 12, 2023.

The DOL, HHS, and IRS issued FAQs providing further guidance addressing the District Court’s recent judgment vacating the preventive services mandate and the obligations of non-grandfathered plans regarding preventive services. The FAQs confirm that non-grandfathered plans must continue to provide preventive services coverage without cost sharing for those items and services recommended with an “A” or “B” rating by the United States Preventive Services Task Force (USPSTF) before March 23, 2010. Moreover, the FAQs clarify that the District Court’s decision in no way prevents non-grandfathered plans from continuing to cover preventive services without cost sharing for items or services recommended by the USPSTF with and “A” or “B” rating on or after March 23, 2010. Furthermore, the FAQS state that items or services recommended by the USPSTF with an “A” or “B” rating on or after March 23, 2010, will continue to be treated as preventive care for purposes of high deductible health plans and health savings account eligibility.