Preventive Service Coverage

Preventive Service Coverage

The Patient Protection and Affordable Care Act (ACA) now requires qualified health plans to cover PrEP as a preventive service at no cost to the patient. Most private insurance plans must provide $0 cost-sharing for at least one PrEP product, so most patients should not need copay assistance programs.

The following infographic summarizes the steps to verify that a given plan is offering PrEP at no cost to the patient. Visit healthcare.gov/see-plans to get started, or visit your state-based marketplace.

NASTAD PrEP Coverage Brief: PrEP Services Covered with No Cost-Sharing: This fact sheet walks through the coverage and cost-sharing requirements for public and private payers that come with this USPSTF Grade A recommendation. It summarizes federal guidance on implementing Preventive Services provisions of the Affordable Care Act (ACA), including new federal sub-regulatory guidance addressing PrEP services released on July 19, 2021.

State-based Marketplaces

California - Covered California

Colorado - Connect for Health Colorado

Connecticut - Access Health CT

District of Columbia - DC Health Link

Idaho - Your Health Idaho

Maryland - Maryland Health Connection

Minnesota-  MNSURE

Massachusetts - Massachusetts Health Connector

Minnesota - MNsure

New York - New York State of Health

New Jersey- Get Covered NJ

Pennsylvania- Pennie

Rhode Island - HealthSource RI

Vermont - Vermont Health Connect

Washington State - Washington Healthplanfinder

For more information about state-based marketplaces, visit the Kaiser Family Foundation’s State Health Insurance Marketplace Types, 2021 resource.