NHeLP Breaks Down Preventive Health Services Standards & Contraceptive Coverage

The Affordable Care Act (ACA) will dramatically expand access to affordable family planning options for women. It promises to do so through two preventive services standards that apply to consumers differently depending on the type of health coverage they receive. The first is contained in Department of Health and Human Services? (HHS) women?s preventive services guidelines (?WPS Guidelines?). The second is a preventive services requirement included in the Essential Health Benefits (EHB) ? the ACA?s fundamental benefits standard that will form the foundation for a wide range of coverage options.

Though both are ?preventive services? requirements, and in spite of significant overlap, the WPS Guidelines and the EHB standard are distinct. The WPS Guidelines will extend coverage of critical preventive services that include contraception, without cost-sharing, to many women covered in the private insurance market both inside and outside of state health insurance Exchanges. The EHB standard will apply to many of the same private plans, but will also extend to enrollees in public insurance programs. Though early guidance assures that both standards will cover the same services, the EHB standard is still being defined and many questions  remain. This paper explains these two standards and analyzes how they differ, interact, and affect contraceptive coverage in different types of private and public health insurance.