{"id":23241,"date":"2025-06-30T17:18:34","date_gmt":"2025-06-30T22:18:34","guid":{"rendered":"https:\/\/www.bbrown.com\/?post_type=insight&p=23241"},"modified":"2025-07-02T12:25:33","modified_gmt":"2025-07-02T17:25:33","slug":"no-cost-preventive-care-services","status":"publish","type":"insight","link":"https:\/\/www.bbrown.com\/us\/insight\/no-cost-preventive-care-services\/","title":{"rendered":"The U.S. Supreme Court Holds that Health Plans must Continue to Provide No-Cost Preventive Care Services that are Recommended by the USPSTF as Required under the ACA"},"content":{"rendered":"

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Employee Benefits<\/p>\n

\n The U.S. Supreme Court Holds that Health Plans must Continue to Provide No-Cost Preventive Care Services that are Recommended by the USPSTF as Required under the ACA\n <\/h1>\n\t\n <\/div>\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\n\t<\/div>\n\n\t\n[\/vc_column][\/vc_row][vc_row][vc_column width=”2\/3″]\n
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\n The U.S. Supreme Court Holds that Health Plans must Continue to Provide No-Cost Preventive Care Services that are Recommended by the USPSTF as Required under the ACA\n <\/h1>\n\t\n <\/div>[vc_column_text css=””]<\/p>\n

Overview<\/h3>\n

On June 27, 2025, the U.S. Supreme Court reversed the Fifth Circuit\u2019s decision and held that the appointment of the U.S. Preventive Services Task Force (USPSTF) is consistent with the Constitution\u2019s Appointments Clause, meaning the USPSTF continues to have the authority to recommended preventive care services under the Affordable Care Act\u2019s (ACA) preventive care services mandate. Previously, the Fifth Circuit had agreed with the District Court\u2019s decision in Braidwood v. U.S. Department of Health and Human Services that the appointment of the USPSTF was unconstitutional. Ultimately, the Supreme Court\u2019s decision means that sponsors of non-grandfathered group health plans must continue to provide preventive care services with no cost-sharing to plan participants as required under the ACA, including those preventive care services recommended by the USPSTF.<\/p>\n

Background and History of Preventive Care Services under the ACA<\/h3>\n

For health plan years beginning on or after September 23, 2010, the ACA requires non-grandfathered group health plans (not including plans that qualify as HIPAA-excepted benefits) to provide coverage for certain categories of preventive services without any cost-sharing.<\/p>\n

There are four categories of mandated preventive care services:<\/p>\n

    \n
  1. USPSTF recommended preventive services that are rated A or B<\/li>\n
  2. Centers for Disease Control and Prevention Advisory Committee on Immunization Practices (ACIP) recommended immunizations<\/li>\n
  3. Additional preventive care and screenings for women not recommended by the USPSTF but provided for in the Health Resources and Services Administration\u2019s (HRSA) guidelines<\/li>\n
  4. Preventive screenings and care for infants, children and adolescents that are provided for in the HSRA guidelines.<\/li>\n<\/ol>\n

    Decisions by the District Court and Fifth Circuit<\/h4>\n

    On March 30, 2023, the Federal District Court for the Northern District of Texas issued an order in Braidwood v. U.S. Department of Health and Human Services (HHS) making the ACA mandate that health plans cover certain preventive care services as recommended by the USPSTF without cost-sharing to the plan participant unenforceable, by way of a nationwide injunction. The Braidwood decision applied only to the first category of mandated preventive services listed above (i.e., USPSTF recommended preventive services). Therefore, the District Court vacated all \u201cagency action taken to implement or enforce the preventive care coverage requirements in response to an \u201cA\u201d or \u201cB\u201d recommendation by the U.S. Preventive Services Task Force on or after March 23, 2010, and made compulsory under [the ACA].\u201d<\/p>\n

    The affected preventive care services included heart disease, lung cancer and depression screenings, among other services. The ruling did not apply with respect to preventive services recommended by the USPSTF prior to March 23, 2010, nor to mandated preventive services included in the other three categories, including services such as mammograms for women over a certain age. The District Court\u2019s nationwide injunction order applied to the plaintiffs in the case, as well as to plan sponsors of non-grandfathered health plans. HHS appealed the District Court\u2019s decision.<\/p>\n

    On June 21, 2024, the U.S. Court of Appeals for the Fifth Circuit upheld the District Court\u2019s decision in part. The Fifth Circuit agreed that the Secretary of HHS did not have the constitutional authority to appoint members of the USPSTF. However, the Fifth Circuit reversed the District Court\u2019s nationwide injunction on enforcement of the preventive services coverage mandate as recommended by the USPSTF, meaning the ACA preventive coverage mandates would continue to apply to those preventive care services recommended by the USPSTF. However, the plaintiffs who filed the original lawsuit were not required to comply with this preventive care mandate.<\/p>\n

    U.S. Supreme Court\u2019s Holding<\/h3>\n

    On June 27, 2025, the U.S. Supreme Court reversed the Fifth Circuit\u2019s decision and held that the Secretary of HHS has the authority in accordance with the Constitution\u2019s Appointments Clause to appointment USPSTF members. Therefore, the USPSTF\u2019s recommendations under the ACA preventive services mandate remain enforceable on non-grandfathered group health plans.<\/p>\n

    Impacts and Considerations<\/h3>\n

    The effect of the Supreme Court\u2019s decision is that plan sponsors should continue to comply with the ACA preventive care services coverage mandate under all four categories mentioned above. Given the abrupt Fifth Circuit\u2019s stay on the District Court\u2019s Braidwood decision, it is unlikely that plan sponsors amended their plans to exclude coverage for, or apply cost-sharing requirements to, the preventive care services recommended by the USPSTF. However, plan sponsors should review their plans with legal counsel to ensure they comply with the ACA preventive services coverage mandate. If changes are necessary, plan sponsors should seek legal advice regarding what actions are necessary to make any desired changes, including whether advance notice of the changes would be required pursuant to the SBC notice of material modification rules.<\/p>\n

    Plan sponsors should be aware that the Fifth Circuit declined to review other plaintiff\u2019s challenges to the authority of the ACIP and HRSA (other governmental agencies that issue preventive care recommendations) and left those decisions to the lower District Court to review. Plan sponsors should be aware that this could potentially result in other challenges to preventive care service recommendations. However, these may be difficult arguments to win given the Supreme Court\u2019s analysis and decision as it relates to the constitutionality of the appointment of USPSTF members.[\/vc_column_text]\t

    \n\t\t\t\t\t\n\t\t\t\tDownload PDF<\/span>\n\t\t\t<\/a>\n\t\t\t<\/div>\n[\/vc_column][vc_column width=”1\/3″][vc_single_image image=”2348″ alignment=”center” style=”vc_box_circle_2″ css=””][vc_separator border_width=”2″ el_width=”60″][vc_column_text css=””]<\/p>\n
    Regulatory and Legislative Strategy Group<\/h6>\n

    [\/vc_column_text][\/vc_column][\/vc_row]<\/p>\n<\/div>","protected":false},"excerpt":{"rendered":"

    [vc_row row_style=”page-hero” full_width=”stretch_row_content”][vc_column][\/vc_column][\/vc_row][vc_row][vc_column width=”2\/3″][vc_column_text css=””] Overview On June 27, 2025, the U.S. Supreme Court reversed the Fifth Circuit\u2019s decision and held that the appointment of the U.S. Preventive Services Task […]<\/p>\n","protected":false},"author":66,"featured_media":30966,"template":"","meta":{"_acf_changed":false,"inline_featured_image":false,"footnotes":""},"insight_category":[31,73],"class_list":["post-23241","insight","type-insight","status-publish","has-post-thumbnail","hentry","insight_category-employee-benefits","insight_category-regulatory-and-legislative-strategy"],"acf":[],"yoast_head":"\nThe U.S. Supreme Court Holds that Health Plans must Continue to Provide No-Cost Preventive Care Services that are Recommended by the USPSTF as Required under the ACA - Brown & Brown<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.bbrown.com\/us\/insight\/no-cost-preventive-care-services\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"The U.S. Supreme Court Holds that Health Plans must Continue to Provide No-Cost Preventive Care Services that are Recommended by the USPSTF as Required under the ACA\" \/>\n<meta property=\"og:description\" content=\"[vc_row row_style=”page-hero” full_width=”stretch_row_content”][vc_column][\/vc_column][\/vc_row][vc_row][vc_column width=”2\/3″][vc_column_text css=””] Overview On June 27, 2025, the U.S. Supreme Court reversed the Fifth Circuit\u2019s decision and held that the appointment of the U.S. Preventive Services Task […]\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.bbrown.com\/us\/insight\/no-cost-preventive-care-services\/\" \/>\n<meta property=\"og:site_name\" content=\"Brown & Brown\" \/>\n<meta property=\"article:modified_time\" content=\"2025-07-02T17:25:33+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/www.bbrown.com\/wp-content\/uploads\/2025\/06\/LinkedIn-Post-RL-Read-Now-scaled.jpg\" \/>\n\t<meta property=\"og:image:width\" content=\"2560\" \/>\n\t<meta property=\"og:image:height\" content=\"1280\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"6 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/www.bbrown.com\\\/us\\\/insight\\\/no-cost-preventive-care-services\\\/\",\"url\":\"https:\\\/\\\/www.bbrown.com\\\/us\\\/insight\\\/no-cost-preventive-care-services\\\/\",\"name\":\"The U.S. Supreme Court Holds that Health Plans must Continue to Provide No-Cost Preventive Care Services that are Recommended by the USPSTF as Required under the ACA - 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