[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-404488-105":59,"doc-detail-404488-en":131},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":124,"head_meta":126,"extra_data":128,"updated_unix":130},105,"en","services-covered-with-no-cost-sharing-prep-coverage-brief","Services Covered with No Cost-Sharing - PrEP Coverage Brief","","Pre-exposure prophylaxis (PrEP) is an effective daily antiretroviral strategy for preventing HIV. Following the USPSTF Grade A recommendation in 2019, the Affordable Care Act requires many commercial health plans and Medicaid expansion programs to cover PrEP without cost-sharing, before deductibles and without coinsurance or copayments, effective for plan years starting Jan 1, 2021 for most plans. The brief also explains required preventive services and implementation timing, and notes that Medicare Part D may still involve cost-sharing.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/services-covered-with-no-cost-sharing-prep-coverage-brief/404488/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/services-covered-with-no-cost-sharing-prep-coverage-brief/404488.png","ImageObject",300,407,{"name":92,"@type":93},"pop out","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-06","2026-09-27",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",13,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"What is PrEP and why is it covered without cost-sharing under USPSTF Grade A?","Question",{"text":113,"@type":114},"PrEP is a once-daily antiretroviral medication used to prevent HIV. Because the USPSTF issued a Grade A recommendation based on substantial net benefit, covered plans generally must provide PrEP without cost-sharing.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"Which plans are required to cover PrEP without cost-sharing?",{"text":118,"@type":114},"Non-grandfathered commercial health plans, including individual marketplace and employer-sponsored plans, must cover PrEP without cost-sharing. State Medicaid expansion coverage programs, including Basic Health Plans, must also cover PrEP without cost-sharing.",{"name":120,"@type":111,"acceptedAnswer":121},"When did the PrEP coverage and cost-sharing requirements take effect?",{"text":122,"@type":114},"Requirements began for plan years starting at least one year after the final USPSTF recommendation. For most plans and Medicaid, this was January 1, 2021, with some non-calendar-year plans implementing earlier.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},404488,1790836016,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":24,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":105,"preview_page_count":4},962090760408,"https://ap-avatar.wpscdn.com/davatar_085a072bc5b1113ac321206ff7593b45","Services Covered with No Cost-Sharing July 2021  \nPre-exposure prophylaxis (PrEP)– a once daily antiretroviral medication taken to prevent HIV – is an incredibly effective HIV prevention tool. In light of its effectiveness and safety, in June, 2019, the US Preventive Services Task Force (USPSTF) gave PrEP an“A” grade recommendation, noting that “the USPSTF concludes with high certainty that the net benefit of the use of PrEP to reduce the risk of acquisition of HIV infection in persons at high risk of HIV infection is substantial.” This fact sheet will walk through the coverage and cost-sharing requirements for public and private payers that come with this USPSTF Grade A recommendation.  \nWhat Does a USPSTF Grade A Recommendation Mean for Coverage and Cost  \nSharing?  \nThe Affordable Care Act (ACA) requires commercial health plans and Medicaid expansion programs to cover select preventive services – including any service with a Grade A or B from the USPSTF – without costsharing, which means that these services must be covered before any deductible and without coinsurance or a copayment. 1 Now that PrEP has a Grade A recommendation from USPSTF, most commercial health plans and Medicaid expansion programs must cover PrEP without cost sharing as of January 1, 2021.  \nPreventive Services  \nThe list of preventive services that must be covered without cost-sharing is based on the recommendations of several expert bodies, including the USPSTF, which is an independent, volunteer panel of national experts in prevention and evidence-based medicine. The USPSTF works to improve the health of all Americans by making evidence-based recommendations about clinical preventive services such as screenings, counseling services, and preventive medications. In addition to PrEP, there are other sexual health services that have a USPSTF A or B grade, including screening for HIV, chlamydia, gonorrhea, HBV, HCV, and Syphilis. A list of preventive services is available at [healthcare.gov/preventive-care-benefits](healthcare.gov/preventive-care-benefits)  \nWhat Plans Must Cover PrEP without Cost Sharing?  \nAll non-grandfathered commercial health plans are required to cover PrEP services without cost sharing. This includes individual marketplace plans, and small and large group employer-sponsored plans. In addition, state Medicaid expansion coverage programs, including Basic Health Plans, must also cover PrEP without cost sharing.  \n1 A summary of Section 2713 in the context of HIV, hepatitis, and STI prevention is available at [cdc.gov/nchhstp/highqualitycare/preventiveservices](cdc.gov/nchhstp/highqualitycare/preventiveservices)  \nThese coverage and cost-sharing requirements do not automatically apply to Medicare prescription drug coverage (Medicare Part D already requires HIV ARVs to be covered, but there will still be cost sharing) .  \nTraditional Medicaid programs (i.e., benefits available to groups outside of the Medicaid expansion population) also have the option of covering recommended preventive services, including USPSTF Grade A and B services, without cost-sharing. States that choose to do this will receive enhanced federal funding. To receive the enhanced federal funding, states must cover all preventive services with a Grade A or B from USPSTF without cost-sharing in both fee-for-service and managed care traditional Medicaid plans. Since 2013, at least fifteen states and the District of Columbia 2 have opted to provide preventive services without cost sharing in their traditional Medicaid programs.  \nWhen Do These New Coverage and Cost-Sharing Requirements for PrEP Go into Effect?  \nThe coverage and cost-sharing requirements for PrEP went into effect for the plan year starting at least one year after the final USPSTF recommendation was released. For most plans and for Medicaid, this was January 1, 2021 (though some plans with non-calendar year plan years had to implement the requirements earlier) . All non-grandfathered plans should now cover","cbCaihfeChOoVnQa","https://ap.wps.com/l/cbCaihfeChOoVnQa","pdf",210337,"English","# What Does a USPSTF Grade A Recommendation Mean for Coverage and Cost Sharing?\n## Preventive Services\n# What Plans Must Cover PrEP without Cost Sharing?\n## Traditional Medicaid programs\n# When Do These New Coverage and Cost-Sharing Requirements for PrEP Go into Effect?\n# What PrEP Services Have to Be Covered without Cost Sharing?\n## Required PrEP Services to Be Covered without Cost Sharing","[{\"question\":\"What is PrEP and why is it covered without cost-sharing under USPSTF Grade A?\",\"answer\":\"PrEP is a once-daily antiretroviral medication used to prevent HIV. Because the USPSTF issued a Grade A recommendation based on substantial net benefit, covered plans generally must provide PrEP without cost-sharing.\"},{\"question\":\"Which plans are required to cover PrEP without cost-sharing?\",\"answer\":\"Non-grandfathered commercial health plans, including individual marketplace and employer-sponsored plans, must cover PrEP without cost-sharing. State Medicaid expansion coverage programs, including Basic Health Plans, must also cover PrEP without cost-sharing.\"},{\"question\":\"When did the PrEP coverage and cost-sharing requirements take effect?\",\"answer\":\"Requirements began for plan years starting at least one year after the final USPSTF recommendation. For most plans and Medicaid, this was January 1, 2021, with some non-calendar-year plans implementing earlier.\"}]","Services Covered with No Cost-Sharing - PrEP Coverage Brief | PDF",1790548231]