The Biden-Harris Administration recently proposed new regulations to expand preventive health service coverage, specifically focusing on birth control and other critical services without cost-sharing. This proposal, initiated by the U.S. Department of Health and Human Services (HHS), aims to make over-the-counter (OTC) contraceptives accessible without requiring a prescription or out-of-pocket expenses, ensuring that millions of Americans can access these resources as part of their health insurance coverage.
Historically, the Affordable Care Act (ACA) mandated that most health plans cover preventive services recommended by the U.S. Preventive Services Task Force and other authorities, without cost-sharing. This includes vaccinations, cancer screenings, and contraception. However, with the political winds shifting, barriers persist, especially regarding contraception, with some insurers requiring prescriptions or cost-sharing. The proposed rule directly addresses these challenges, mandating that plans cover a range of contraceptive options, from oral pills to intrauterine devices (IUDs), without a prescription, making preventive care more accessible to women.
According to the CMS Newsroom briefing of Oct. 21, HHS Secretary Xavier Becerra emphasized that this initiative aligns with the Administration’s commitment to women’s healthcare. “Every woman should have access to the healthcare she needs,” he stated, affirming that insurers and providers must meet their obligations under the law. Centers for Medicare & Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure added that this move is critical to ensuring that people can make personal healthcare decisions free from financial barriers, allowing them to choose their preferred birth-control method without the added concern of cost.
Beyond contraception, the proposed rules reinforce health plans’ responsibilities for broader preventive care. The ACA’s preventive services mandate covers essential screenings, immunizations, and other healthcare provisions without requiring copayments, coinsurance, or deductibles. By clarifying the coverage process and mandating accessible disclosure of OTC contraceptive options on insurance plan tools, the Administration seeks to prevent administrative barriers and ensure that consumers understand their coverage.
In light of recent Supreme Court decisions affecting reproductive rights, such as the 2022 Dobbs v. Jackson Women’s Health Organization ruling that overturned Roe v. Wade, the Administration’s proposal also aligns with President Biden’s executive orders on reproductive healthcare. These rules are a response to reinforce federal protections and ensure affordable access to reproductive healthcare services, in efforts to preserve these rights across various states and their legal stances.
Additional guidance from the Departments also seeks to clarify requirements under the ACA and other federal healthcare policies, such as the Women’s Health and Cancer Rights Act, which mandates coverage for procedures like chest wall reconstruction after a mastectomy. This guidance also addresses common challenges with claim denials for preventive services, emphasizing proper coding procedures to avoid unjust cost-sharing charges.
Through these rules, the Administration is making a play to protect the right to accessible and affordable preventive women’s health, particularly for reproductive services, by removing unnecessary barriers. The regulations aim to ensure that contraceptives remain affordable and accessible for all.
There has been a noticeable increase in payer actions regarding readmission denials, often justified as efforts to enhance quality of care and align with Medicare’s
The Centers for Medicare & Medicaid Services (CMS) released in its 2025 Outpatient Prospective Payment System (OPPS) Final Rule a new Conditions of Participation (CoPs)
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