The Affordable Care Act (ACA), enacted on March 23, 2010, represents a landmark effort to make healthcare more accessible and affordable for all Americans. A key component of this legislation is its emphasis on preventive care, particularly for women. By mandating most health insurance plans to cover a range of preventive services without cost-sharing, the ACA aims to ensure that women can access essential healthcare services proactively, leading to improved health outcomes and overall well-being.
This article delves into the specific women’s health programs and services covered under the Affordable Care Act, highlighting how this legislation has transformed access to crucial preventive care for women across the United States.
The Affordable Care Act and Women’s Preventive Health Services: A Closer Look
Section 2713 of the Public Health Service Act, as reinforced by the ACA, plays a pivotal role in ensuring women’s access to preventive healthcare. It stipulates that non-grandfathered group health plans and health insurance coverage must cover specified preventive services without imposing copayments, coinsurance, deductibles, or any other form of cost-sharing. This mandate extends to preventive care and screenings for women, guided by comprehensive guidelines supported by the Health Resources and Services Administration (HRSA).
The underlying principle of these guidelines is the recognition of the unique health needs women face throughout their lives. The Women’s Preventive Services Initiative (WPSI), with the support of HRSA, is dedicated to enhancing women’s health across all stages of life. This is achieved by identifying essential preventive services and screenings that should be integrated into clinical practice and, upon HRSA endorsement, incorporated into the nationally recognized guidelines.
HRSA-Supported Women’s Preventive Services Guidelines: Development and Evolution
The foundation of the HRSA-supported Women’s Preventive Services Guidelines was laid in 2011, drawing upon recommendations from a study commissioned by the Department of Health and Human Services and conducted by the Institute of Medicine (IOM), now known as the National Academy of Medicine (NAM). This initial framework aimed to bridge gaps in women’s preventive care.
Recognizing the continuous advancements in medical science and the evolving understanding of clinical practice gaps, HRSA launched the Women’s Preventive Services Initiative (WPSI) in 2016. This five-year cooperative agreement with the American College of Obstetricians and Gynecologists (ACOG) tasked a coalition of experts to rigorously review and update the guidelines. The WPSI expert panel adopted a scientifically sound approach, aligning with the NAM’s established model for trustworthy clinical practice guidelines.
A subsequent cooperative agreement was awarded to ACOG in March 2021, ensuring ongoing review and updates to the Guidelines. Under ACOG’s leadership, WPSI systematically reviews existing guidelines at least every five years, or more frequently as new scientific evidence emerges or new preventive service topics are identified. The WPSI website actively encourages submissions of new topics for consideration, ensuring the guidelines remain responsive to the latest healthcare needs of women.
Updated Women’s Preventive Services Guidelines: Enhancements for 2026
HRSA has recently approved updates to the Women’s Preventive Services Guidelines, demonstrating a commitment to incorporating the most current medical knowledge into women’s healthcare. These updates, approved in December 2024, refine two existing preventive services and introduce a new guideline, all set to take effect for plan years starting in 2026.
The updated guidelines focus on:
- Screening and Counseling for Intimate Partner and Domestic Violence: This updated guideline expands upon the previous recommendation.
- Breast Cancer Screening for Women at Average Risk: This guideline refines recommendations for mammography screening.
- Patient Navigation Services for Breast and Cervical Cancer Screening: This is a newly introduced guideline to improve screening uptake.
The table below details these updated guidelines:
| Type of Preventive Service | Current Guidelines | Updated Guideline Beginning with Plan Years Starting in 2026 |
|---|---|---|
| Screening and Counseling for Intimate Partner and Domestic Violence | WPSI recommends screening adolescents and women for interpersonal and domestic violence, at least annually, and, when needed, providing or referring for initial intervention services. Interpersonal and domestic violence includes physical violence, sexual violence, stalking and psychological aggression (including coercion), reproductive coercion, neglect, and the threat of violence, abuse, or both. Intervention services include, but are not limited to, counseling, education, harm reduction strategies, and referral to appropriate supportive services. | The Women’s Preventive Services Initiative recommends screening adolescent and adult women for intimate partner and domestic violence, at least annually, and, when needed, providing or referring to intervention services. Intimate partner and domestic violence includes physical violence, sexual violence, stalking and psychological aggression (including coercion), reproductive coercion, neglect, and the threat of violence, abuse, or both. Intervention services include, but are not limited to, counseling, education, harm reduction strategies, and appropriate supportive services. |
| Breast Cancer Screening for Women at Average Risk | WPSI recommends that average-risk women initiate mammography screening no earlier than age 40 and no later than age 50. Screening mammography should occur at least biennially and as frequently as annually. Screening should continue through at least age 74 and age alone should not be the basis to discontinue screening. These screening recommendations are for women at average risk of breast cancer. Women at increased risk should also undergo periodic mammography screening, however, recommendations for additional services are beyond the scope of this recommendation. | The Women’s Preventive Services Initiative recommends that women at average risk of breast cancer initiate mammography screening no earlier than age 40 years and no later than age 50 years. Screening mammography should occur at least biennially and as frequently as annually. Women may require additional imaging to complete the screening process or to address findings on the initial screening mammography. If additional imaging (e.g., magnetic resonance imaging (MRI), ultrasound, mammography) and pathology evaluation are indicated, these services also are recommended to complete the screening process for malignancies. Screening should continue through at least age 74 years, and age alone should not be the basis for discontinuing screening. Women at increased risk also should undergo periodic mammography screening, however, recommendations for additional services are beyond the scope of this recommendation. |
New Guideline: Patient Navigation Services for Breast and Cervical Cancer Screening
A significant addition to the guidelines is the introduction of Patient Navigation Services for Breast and Cervical Cancer Screening. Recognizing that navigating the healthcare system can be challenging, especially after receiving screening results, this new guideline aims to improve access to and utilization of recommended screenings and follow-up care.
| Type of Preventive Service | New Guideline Beginning with Plan Years Starting in 2026 |
|---|---|
| Patient Navigation Services for Breast and Cervical Cancer Screening | The Women’s Preventive Services Initiative recommends patient navigation services for breast and cervical cancer screening and follow-up, as relevant, to increase utilization of screening recommendations based on an assessment of the patient’s needs for navigation services. Patient navigation services involve person-to-person (e.g., in-person, virtual, hybrid models) contact with the patient. Components of patient navigation services should be individualized. Services include, but are not limited to, person-centered assessment and planning, health care access and health system navigation, referrals to appropriate support services (e.g., language translation, transportation, and social services), and patient education. |
These services are designed to be person-centered and may include various components such as:
- Personalized assessment and care planning.
- Guidance through the healthcare system.
- Referrals to essential support services like transportation, translation, and social services.
- Patient education to empower informed decision-making.
Current Women’s Preventive Services Guidelines: A Comprehensive Suite of Care
Beyond the updated and new guidelines, the ACA mandates coverage without cost-sharing for a broad spectrum of preventive services for women. These current guidelines, supported by HRSA, encompass a wide range of health needs specific to women across different life stages:
| Type of Preventive Service | Current Guidelines |
|---|---|
| Screening for Anxiety | WPSI recommends screening for anxiety in adolescent and adult women, including those who are pregnant or postpartum. Optimal screening intervals are unknown and clinical judgement should be used to determine screening frequency. Given the high prevalence of anxiety disorders, lack of recognition in clinical practice, and multiple problems associated with untreated anxiety, clinicians should consider screening women who have not been recently screened. |
| Screening for Cervical Cancer | WPSI recommends cervical cancer screening for average-risk women aged 21 to 65 years. For women aged 21 to 29 years, the Women’s Preventive Services Initiative recommends cervical cancer screening using cervical cytology (Pap test) every 3 years. Cotesting with cytology and human papillomavirus testing is not recommended for women younger than 30 years. Women aged 30 to 65 years should be screened with cytology and human papillomavirus testing every 5 years or cytology alone every 3 years. Women who are at average risk should not be screened more than once every 3 years. |
| Obesity Prevention in Midlife Women | WPSI recommends counseling midlife women aged 40 to 60 years with normal or overweight body mass index (BMI) (18.5-29.9 kg/m2) to maintain weight or limit weight gain to prevent obesity. Counseling may include individualized discussion of healthy eating and physical activity. |
| Breastfeeding Services and Supplies | WPSI recommends comprehensive lactation support services (including consultation; counseling; education by clinicians and peer support services; and breastfeeding equipment and supplies) during the antenatal, perinatal, and postpartum periods to optimize the successful initiation and maintenance of breastfeeding.Breastfeeding equipment and supplies include, but are not limited to, double electric breast pumps (including pump parts and maintenance) and breast milk storage supplies. Access to double electric pumps should be a priority to optimize breastfeeding and should not be predicated on prior failure of a manual pump. Breastfeeding equipment may also include equipment and supplies as clinically indicated to support dyads with breastfeeding difficulties and those who need additional services. |
| Contraception | WPSI recommends that adolescent and adult women have access to the full range of contraceptives and contraceptive care to prevent unintended pregnancies and improve birth outcomes. Contraceptive care includes screening, education, counseling, and provision of contraceptives (including in the immediate postpartum period). Contraceptive care also includes follow-up care (e.g., management, evaluation and changes, including the removal, continuation, and discontinuation of contraceptives). WPSI recommends that the full range of U.S. Food and Drug Administration (FDA)- approved, -granted, or -cleared contraceptives, effective family planning practices, and sterilization procedures be available as part of contraceptive care. The full range of contraceptives includes those currently listed in the FDA’s Birth Control Guide: (1) sterilization surgery for women, (2) implantable rods, (3) copper intrauterine devices, (4) intrauterine devices with progestin (all durations and doses), (5) injectable contraceptives, (6) oral contraceptives (combined pill), 7) oral contraceptives (progestin only), (8) oral contraceptives (extended or continuous use), (9) the contraceptive patch, (10) vaginal contraceptive rings, (11) diaphragms, (12) contraceptive sponges, (13) cervical caps, (14) condoms, (15) spermicides, (16) emergency contraception (levonorgestrel), and (17) emergency contraception (ulipristal acetate), and any additional contraceptives approved, granted, or cleared by the FDA. Additionally, instruction in fertility awareness-based methods, including the lactation amenorrhea method, although less effective, should be provided for women desiring an alternative method. |
| Counseling for Sexually Transmitted Infections (STIs) | WPSI recommends directed behavioral counseling by a health care clinician or other appropriately trained individual for sexually active adolescent and adult women at an increased risk for STIs. WPSI recommends that clinicians review a woman’s sexual history and risk factors to help identify those at an increased risk of STIs. Risk factors include, but are not limited to, age younger than 25, a recent history of an STI, a new sex partner, multiple partners, a partner with concurrent partners, a partner with an STI, and a lack of or inconsistent condom use. For adolescents and women not identified as high risk, counseling to reduce the risk of STIs should be considered, as determined by clinical judgment. |
| Human Immunodeficiency Virus Infection (HIV) | WPSI recommends all adolescent and adult women, ages 15 and older, receive a screening test for HIV at least once during their lifetime. Earlier or additional screening should be based on risk, and rescreening annually or more often may be appropriate beginning at age 13 for adolescent and adult women with an increased risk of HIV infection.WPSI recommends risk assessment and prevention education for HIV infection beginning at age 13 and continuing as determined by risk. A screening test for HIV is recommended for all pregnant women upon initiation of prenatal care with rescreening during pregnancy based on risk factors. Rapid HIV testing is recommended for pregnant women who present in active labor with an undocumented HIV status. Screening during pregnancy enables prevention of vertical transmission. |
| Well-Woman Preventative Visits | WPSI recommends that women receive at least one preventive care visit per year beginning in adolescence and continuing across the lifespan to ensure the provision of all recommended preventive services, including preconception and many services necessary for prenatal and interconception care, are obtained. The primary purpose of these visits should be the delivery and coordination of recommended preventive services as determined by age and risk factors. These services may be completed at a single or as part of a series of visits that take place over time to obtain all necessary services depending on a woman’s age, health status, reproductive health needs, pregnancy status, and risk factors. Well-women visits also include prepregnancy, prenatal, postpartum and interpregnancy visits. |
| Screening for Diabetes in Pregnancy | The Women’s Preventive Services Initiative recommends screening pregnant women for gestational diabetes mellitus after 24 weeks of gestation (preferably between 24 and 28 weeks of gestation) to prevent adverse birth outcomes. WPSI recommends screening pregnant women with risk factors for type 2 diabetes or GDM before 24 weeks of gestation—ideally at the first prenatal visit. |
| Screening for Diabetes after Pregnancy | The WPSI recommends screening for type 2 diabetes in women with a history of gestational diabetes mellitus (GDM) who are not currently pregnant and who have not previously been diagnosed with type 2 diabetes. Initial testing should ideally occur within the first year postpartum and can be conducted as early as 4–6 weeks postpartum. Women who were not screened in the first year postpartum or those with a negative initial postpartum screening test result should be screened at least every 3 years for a minimum of 10 years after pregnancy. For those with a positive screening test result in the early postpartum period, testing should be repeated at least 6 months postpartum to confirm the diagnosis of diabetes regardless of the type of initial test (e.g., fasting plasma glucose, hemoglobin A1c, oral glucose tolerance test). Repeat testing is also indicated for women screened with hemoglobin A1c in the first 6 months postpartum regardless of whether the test results are positive or negative because the hemoglobin A1c test is less accurate during the first 6 months postpartum. |
| Screening for Urinary Incontinence | The Women’s Preventive Services Initiative recommends screening women for urinary incontinence annually. Screening should assess whether women experience urinary incontinence and whether it impacts their activities and quality of life. If indicated, facilitating further evaluation and treatment is recommended. |
This comprehensive list underscores the ACA’s commitment to women’s health, ensuring access to vital preventive services across a woman’s lifespan.
Implementation and Access to Women’s Health Programs
The Women’s Preventive Services Initiative, through ACOG, provides valuable implementation considerations to facilitate the integration of these guidelines into clinical practice. These resources, available on the Women’s Preventive Services Initiative website, offer practical guidance for healthcare providers.
Non-grandfathered health plans are mandated to provide coverage without cost-sharing for these services, aligning with the HRSA guidelines. Updated guidelines typically take effect for plan years commencing one year after HRSA acceptance. In the interim, plans are generally required to adhere to the previously updated guidelines.
It’s important to note that there are religious and moral exemptions related to the contraceptive coverage mandate, as detailed in 45 CFR 147.132 and 45 CFR 147.133.
Conclusion: The Affordable Care Act’s Enduring Impact on Women’s Health
The Affordable Care Act has fundamentally reshaped the landscape of women’s healthcare in the United States. By ensuring no-cost coverage for a comprehensive suite of preventive services, the ACA empowers women to proactively manage their health and well-being. From essential screenings for cancer and HIV to vital counseling services and access to contraception and breastfeeding support, these programs represent a significant stride towards health equity and improved health outcomes for women across the nation. Understanding these covered programs is crucial for women to fully leverage the benefits of the Affordable Care Act and prioritize their preventive healthcare needs.
