Supreme Court Ruling on Preventive Services

Preventive services are still covered at no cost

On June 27, 2027, the U.S. Supreme Court ruled that preventive health care services will remain covered at no cost under the Affordable Care Act (ACA).    It ruled that the U.S. Preventive Services Task Force (USPSTF) can keep working the way it has been since June of 2023. This group helps decide which medical tests and check-ups should be covered for free under the Affordable Care Act (ACA). 

This decision matters for businesses, insurance companies, and workers because it affects what healthcare services are available at no cost. 

The good news: No action needed for group health plans. 

The court’s 6-3 decision ensures that those with private health insurance will continue to have access to preventive care, including cancer screenings, vaccines, HIV drugs, and counselling at no added cost.   

What this Means for Employers and Brokers:

Changes in membership caused by political shifts may trigger changes in UPSTF’s preventative services recommendations. This is why the next steps outlined below are critical for understanding what is best for employer group health plans. 

Next Steps for Employers and Brokers: 

• Stay Informed: Monitor for potential changes to UPSTF’s membership to understand how the decision may affect your compliance obligations.  

• Evaluate Preventative Coverage: Review your plan’s preventative services coverage to assess its impact on benefits strategy, potential costs, and employee satisfaction.  

• Analyze Employee Utilization: Examine how your workforce is using preventative services to identify trends and opportunities for improvement.  

• Leverage Compliance Tools: Simplify compliance management with tools like ComplianceDashboard, offering customized calendars and proactive reminders to keep you on track. 

Background:

The Affordable Care Act (ACA) requires non-grandfathered health plans to cover certain preventive health services at no cost to participants. Instead of specifying the services, the ACA tasked three agencies with determining what must be covered: the U.S. Preventive Services Task Force (USPSTF), the Health Resources and Services Administration (HRSA), and the Advisory Committee on Immunization Practices (ACIP). The USPSTF helps ensure preventive services are accessible without cost-sharing.   

Final Thoughts:

As things continue to evolve in healthcare, employer group health plans should continue to monitor changes in UPSTF membership and policy shifts.  However, prior to any possible shifts, it is imperative employer group health plans understand how and why members utilize preventative care.  Therefore, if any shifts occur to preventative care requirements, group health plans may make the best financial adjustments for their plans and employee attraction and retention.  Prevention of major health conditions may lead to positive outcomes for members that keep healthcare costs lower than if those preventable diseases were not mitigated early. 

If you’re finding compliance too complicated to tackle alone, consider leveraging solutions like ComplianceDashboard to simplify the process. Stay ahead of the changes and make compliance work for you—not against you. 

Stay compliant. Stay informed.