Preventive Service Coverage
A recent ruling in the case of Braidwood Management, Inc. v. Becerra could affect some of the information on this page. Click here to read more. NASTAD will continue to monitor this situation and update this page as needed.
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.
PrEP Coverage Check—A PrEP Verification Tool: This tool aims to assist PrEP navigators and enrollment assisters quickly verify whether PrEP medications are covered in select health plans throughout the 2023 Open Enrollment Period.
PrEP Cost Sharing Complaint Template: The PrEP Cost Sharing Complaint Template is meant to assist providers and patients file a complaint about an uncompliant health plan charging for PrEP services.
California - Covered California
Colorado - Connect for Health Colorado
Connecticut - Access Health CT
District of Columbia - DC Health Link
Idaho - Your Health Idaho
Kentucky - Kynect
Maine - CoverME
Maryland - Maryland Health Connection
Massachusetts - Massachusetts Health Connector
Minnesota - MNsure
Nevada - NevadaHealthLink
New Mexico - BewellNM
New York - New York State of Health
New Jersey - Get Covered NJ
Pennsylvania - Pennie
Rhode Island - HealthSourceRI
Vermont - Vermont Health Connect
Virginia- Virginia Health Benefit Exchange
Washington State - Washington Healthplanfinder
For more information about state-based marketplaces, visit the KFF State Health Insurance Marketplace Types resource.