ACA includes specific coverage requirements for clinical preventive services and applies the requirements of Section 2713 to different insurance types. Discuss the different insurance types and the differences of each

Answer 1

• Private employer-based plans: Most employer-based plans must cover all Section 2713 services with no cost-sharing imposed on the enrollee (no deductible, co-payments, or coinsurance).
• Individual and small-group plans: Most individual plans, whether or not purchased through an Exchange, must cover all Section 2713 services with no cost-sharing.
• Medicaid:
o The "expansion" population: In states expanding Medicaid, the newly eligible population is entitled to all Section 2713 services without cost-sharing.
o The "traditional" population: In all states, people in traditional eligibility categories are not automatically entitled to any of the Section 2713 services, and even if these preventive services are covered, beneficiaries may be responsible for co-payments or other forms of cost-sharing.
• Medicare: The Medicare program does not have to cover Section 2713 services. However, if Medicare does cover a USPSTF-recommended service, ACA requires that it do so with no cost-sharing imposed on the beneficiary.