Prediabetes Screening Recommendation Adjusted from Age 40 to 35

The US Preventive Services Task Force (USPSTF) regularly reviews and updates a list of recommendations for preventive care which should be utilized in current medicine.  The Affordable Care Act (ACA) mandates that all non-grandfathered plans must cover these USPSTF recommendations with an A or B rating with no in-network cost sharing to the member.  When a recommendation is updated, the plan must cover the adjusted recommendation with the plan year beginning on/after the one-year anniversary of the updated recommendation.

On Tuesday, August 24, 2021, the USPSTF updated its prediabetes screening recommendation for those with overweight or obesity from age 40 to age 35.  As a result, non-grandfathered plan years beginning on/after September 1, 2022, will need to ensure this screening is covered in-network without cost sharing down to age 35 for those with overweight or obesity.

IMA will continue to monitor regulator guidance and offer meaningful, practical, timely information.

This material should not be considered as a substitute for legal, tax and/or actuarial advice. Contact the appropriate professional counsel for such matters. These materials are not exhaustive and are subject to possible changes in applicable laws, rules, and regulations and their interpretations.