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47 Million Women Have Guaranteed Access to Women's Preventive Services with Zero Cost-Sharing Under the Affordable Care Act

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ASPE Issue Brief

47 Million Women Will Have Guaranteed Access To Women's Preventive Services With Zero Cost-Sharing Under The Affordable Care Act

July 31, 2012

By: Adelle Simmons and Laura Skopec


This issue brief is available on the Internet at:

Printer friendly version in PDF format (5 pages)[Free PDF reader Exit disclaimer]



The Affordable Care Act requires many insurance plans (so-called ’non-grandfathered’ plans) to provide coverage for and eliminate cost-sharing on certain recommended preventive health services, for policies renewing or issued on or after September 23, 2010.[1] Many of these recommended preventive services are based on guidelines from the U.S. Preventive Services Task Force.[2]

In addition, pursuant to the Affordable Care Act, in August 2011, the Department of Health and Human Services (HHS) Health Resources and Services Administration published guidelines on women?s preventive services that require non-grandfathered health insurance plans to cover certain recommended preventive services specifically for women, without charging a co-pay, co-insurance or a deductible beginning in plan years starting on or after August 1, 2012.? The Guidelines are based on recommendations to the Department from the Institute of Medicine (IOM).? The Department provided for an exemption for certain religious employers, and a transition is provided for certain additional non-profit organizations with religious objections to contraception coverage.[3]

Based on the most recent data from the Census Bureau, we estimate that under the Affordable Care Act, approximately 47 million women will have guaranteed access to these additional preventive services without cost-sharing for policies renewing on or after August 1, 2012.[4] These services include well-woman visits, screening for gestational diabetes, HPV DNA testing, domestic violence screening and counseling, HIV screening and counseling for sexually transmitted infections, breastfeeding supplies, contraceptive methods and family planning counseling. Increased access to these services will help improve health and well-being among women. For example, family planning services improve maternal health and birth outcomes through encouraging appropriately spaced pregnancies, and breastfeeding support can help improve child health and development.[5] Also, rates of gestational diabetes range from 2% to 10% of pregnancies in the United States. Preventive screenings for women with gestational diabetes are especially important given that these women are more likely to develop diabetes after pregnancy.[6]

We estimated how the 47 million women in non-grandfathered plans are distributed across states, and across racial/ethnic groups. Table 1 presents the national total and totals by state.[7] Figure 1 presents breakdowns by race and ethnicity.[8]

The estimates in this brief are based on the 2010 Current Population Survey and reflect the total number of women ages 15-64 with private health insurance, discounted by the proportion of individuals estimated to be enrolled in grandfathered plans. These estimates do not take into account that the proportion of grandfathered plans may vary by state, that some women may already have coverage for these services without cost-sharing, or that some employers are exempt from the requirement to provide these benefits.


Number of Women Estimated to Receive Guaranteed Women’s Preventive Health Services without Cost-Sharing under the Affordable Care Act, by State
State Number of Women
Alabama 742,787
Alaska 107,031
Arizona 916,996
Arkansas 388,275
California 5,306,748
Colorado 868,691
Connecticut 637,900
Delaware 144,717
District of Columbia 101,816
Florida 2,489,759
Georgia 1,481,402
Hawaii 210,665
Idaho 222,749
Illinois 2,048,961
Indiana 983,850
Iowa 519,908
Kansas 450,915
Kentucky 650,425
Louisiana 592,117
Maine 212,588
Maryland 1,042,794
Massachusetts 1,212,350
Michigan 1,557,614
Minnesota 899,810
Mississippi 381,704
Missouri 940,103
Montana 140,400
Nebraska 306,915
Nevada 391,181
New Hampshire 253,146
New Jersey 1,445,004
New Mexico 259,439
New York 3,092,653
North Carolina 1,352,427
North Dakota 110,215
Ohio 1,852,561
Oklahoma 555,857
Oregon 633,784
Pennsylvania 2,121,806
Rhode Island 174,974
South Carolina 649,693
South Dakota 132,029
Tennessee 960,501
Texas 3,412,175
Utah 465,617
Vermont 109,043
Virginia 1,376,205
Washington 1,095,830
West Virginia 258,764
Wisconsin 967,875
Wyoming 84,685
US Total 47,315,456
FIGURE 1: Number of Women Estimated to Receive Guaranteed Women's Preventive Health Services without Cost-Sharing under the Affordable Care Act, by Race and Ethnicity (in Millions)[9]
Graph of Number of Women Estimated to Receive Guaranteed Women's Preventive Health Services



[1] Preventive Regulations. U.S. Departments of Treasury; Labor; and Health and Human Services.

[2]Preventive services include colonoscopy screening for colon cancer, well-child visits, flu shots for all children and adults, and other services.   Recommended Preventive Services. U.S. Department of Health and Human Services, 2011.  Accessed at:  (

[3] The Guidelines were published alongside an amendment to the July 2010 Preventive Services Rule that required non-grandfathered health plans to cover certain recommended preventive services without cost-sharing..

[4] Data come from the Census Bureau’s Current Population Survey, for the year 2010, for women ages 15-64 with private health insurance coverage, excluding those who also report Medicare coverage. The total number of women from the CPS was then discounted by an estimate of the proportion of people enrolled in grandfathered coverage. The 2011 Kaiser Family Foundation Employer survey was used to estimate the fraction of employees in grandfathered plans in 2011, and we assumed that the fraction of employers who would relinquish grandfathered status in 2012 would be equal to the fraction that relinquished this status in 2011. We do not have data to determine current cost-sharing on these services, so this estimate may include some women who already have no cost-sharing on these services. However, from anecdotal information, we expect there are very few women with zero cost-sharing coverage currently for domestic violence screening, and relatively few with zero cost-sharing for contraceptive services. Further, we have not adjusted the estimate to reflect women who are covered by religiously-affiliated institutions.

[5] Institute of Medicine (2011). Clinical Preventive Services for Women: Closing the Gaps. Washington, D.C.

[6]Centers for Disease Control and Prevention (2011). 2011 National Diabetes Fact Sheet

[7] These estimates assume that the fraction of people with private insurance in non-grandfathered plans is uniform across states and race/ethnicity groups.

[8] The Census Bureau records race and ethnicity separately, so the numbers presented in Figure 1 add to more than the total number of privately insured women ages 15-64 in the CPS.

[9] The Census Bureau records race and ethnicity separately, so the numbers presented in Figure 1 add to more than the total number of privately insured women ages 15-64 in the CPS. Specifically, individuals reporting Latino ethnicity have also reported one of the race categories shown in Figure 1.