The landscape of preventive care coverage is undergoing shifts, and employers must stay informed to ensure compliance and provide comprehensive healthcare benefits to their employees. In this blog post, we’ll discuss key changes impacting the Affordable Care Act’s (ACA) preventive care coverage requirements for 2024 and beyond.
Conclusion of COVID-19 Coverage Requirements:
With the conclusion of the COVID-19 public health emergency, health plans are no longer obligated to cover diagnostic tests and related services without cost sharing. However, immunizations must still be covered, though the requirement can now be limited to in-network providers. Employers must assess the impact on their coverage and communicate any changes to plan participants.
Legal Challenges to Preventive Care Mandate:
In March 2023, a U.S. District Court ruled a key component of the ACA’s preventive care mandate as unconstitutional. The Biden administration has appealed the decision, and until a resolution is reached, non-grandfathered health plans must continue to cover preventive care services without cost sharing. Employers should stay vigilant and consult with issuers or TPAs to understand the potential impact on their health coverage.
Potential Expansion of Contraceptive Coverage:
The federal government is exploring ways to enhance access to contraceptives, possibly expanding the ACA’s preventive care mandate to include over-the-counter (OTC) preventive products. Employers should monitor developments, especially with the approval of the first nonprescription daily oral contraceptive, Opill. Adjustments to health plan coverage may be necessary to accommodate any changes in coverage requirements for OTC preventive products.
Adapting to Changes in Contraceptive Coverage Mandates:
Employers who wish to cover OTC contraceptives on a first-dollar basis should consult with issuers and TPAs to expand their health plan’s coverage. Those with health FSAs or HRAs can design these accounts to reimburse all OTC drugs, while employees with HSAs can utilize their funds for tax-free payments on OTC medicines, including contraceptives.
Potential Changes in Exemptions to Contraceptive Coverage:
The Biden administration aims to narrow exemptions to the ACA’s contraceptive coverage mandate. While churches and houses of worship remain exempt, a proposed rule in January 2023 seeks to eliminate the moral exemption, retaining only the religious exemption. Employers relying on the moral exemption should monitor the release of a final rule in 2024 and adjust health coverage accordingly. Staying abreast of these changes is crucial for employers to navigate the evolving landscape of preventive care coverage. By understanding the impact of legal decisions, adjusting to shifts in COVID-19 coverage requirements, and anticipating potential expansions in contraceptive coverage, employers can ensure they provide comprehensive and compliant healthcare benefits to their workforce in 2024 and beyond.