Managing Costs

Part of the Affordable Care Act allows for preventative services that benefit women, pregnant women, children, adolescents, and other adults. Under the ACA there are several vaccines that are provided with no-cost sharing (i.e. no co-pay) for children, adolescents, and adults. Those vaccines include:

Children

• Diphtheria, Tetanus, Pertussis
• Haemophilius influenzae type b
• Hepatitis A
• Hepatitis B
• Quadrivalent Human Papillomavirus vaccine
• Inactivated Poliovirus
• Influenza
• Measles, Mumps, Rubella
• Meningococcal
• Rotavirus
• Varicella

Adults

• Hepatitis A
• Hepatitis B
• Herpes Zoster
• Quadrivalent Human Papillomavirus vaccine
• Influenza
• Measles, Mumps, Rubella
• Meningococcal
• Pneumococcal
• Tetanus, Diphtheria, Pertussis
• Varicella

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As part of the Affordable Care Act (ACA) immunizations including human papillomavirus (HPV), influenza (flu), and tetanus, diphtheria, and pertussis (Tdap) are required to be covered at no charge for women, including those who are pregnant or nursing. These requirements apply to all non-grandfathered private health insurance plans and went into effect in the first full plan year beginning on or after September 23, 2010. For additional detailed information on the Affordable Care Act and Women’s Health visit Healthcare.gov or read the ASPE Issue Brief.

FAQs about Affordable Care Act Implementation (Part XII) prepared jointly by the Departments of Labor, Health and Human Services (HHS), and the Treasury and published February 20, 2013.

• The Advisory Committee on Immunization Practices (ACIP) section (see pg. 5) clarifies that for vaccines with permissive (Category B) recommendation, if the vaccine is prescribed by a health care provider consistent with the ACIP recommendations, a plan or issuer is required to provide coverage for the vaccine without cost-sharing. This clarification was made following publication of the HHS interim final rule regarding coverage of preventive services under the ACA, which references coverage for “immunizations for routine use”.

In addition to any Advisory Committee on Immunization Practices (ACIP)-recommended immunizations, the ACA requires that the following services be covered by the plan without co-pay and and/or deductibles to the patient:

• United States Preventive Services Task Force A and B-rated services,
• Services detailed in the Bright Futures program for health promotion and disease prevention in children and adolescents, and
• Additional services for women which include:
  - Well-woman visits
  - Gestational diabetes screening
  - Domestic and interpersonal violence screening and counseling
  - FDA-approved contraceptive methods, and contraceptive education and counseling
  - Breastfeeding support, supplies, and counseling
  - HPV DNA testing, for women 30 or older
  - Sexually transmitted infections counseling for sexually-active women
  - HIV screening and counseling for sexually-active women