Preventive Care Coverage Post-Braidwood: Implications for Employer-Sponsored Plans, Medicaid, and Medicare

In response to the recent federal district court decision in Braidwood Management. v. Becerra, the Departments of Labor, Treasury, and Health and Human Services issued guidance for group health plans on required preventive services coverage. The court ruling significantly impacts the ACA preventive care services mandate for health plans and counsel and plan sponsors must review plan documents and coverages in light of the court ruling and recent guidance.

The ACA requires private health insurance plans to cover a range of recommended preventive services without any patient cost-sharing. These preventive services include screening tests, immunizations, behavioral counseling, and medications that can prevent the development or worsening of health conditions.

Prior to the Braidwood decision, the ACA required non-grandfathered group health plans and issuers to cover certain preventive services and items without participant cost-sharing when provided in-network. Now, the court ruling essentially removes the preventive services mandate for certain categories. The court decision applies only to recommended items and services with an "A" or "B" rating by the United States Preventive Services Task Force on or after Mar. 23, 2010, with all other preventive care requirements remaining in place.

Listen as our panel discusses recent litigation challenging the preventive care services requirements under the ACA, the impact on preventive services for private health plans, Medicare, and Medicaid, as well as next steps for counsel and plan sponsors.