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.
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 2022 Open Enrollment Period.
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
Washington State - Washington Healthplanfinder
For more information about state-based marketplaces, visit the Kaiser Family Foundation’s State Health Insurance Marketplace Types, 2022 resource.