TB Preventive Services

The Affordable Care Act requires coverage of recommended preventive services without cost-sharing for the following health plans:

  1. Non-grandfathered private health insurance plans – Most private insurance plans, including all plans on the Health Insurance Marketplace, and all group or individual health insurance plans that did not exist on March 23, 2010—or that have made significant changes to benefits, cost-sharing, or limits since that time—are required to cover services without cost-sharing.1,2
  2. Medicare – All USPSTF recommended services that have a Grade “A” or “B” and that are covered by Medicare must be covered without cost-sharing.3
  3. Medicaid expansion plans in states that expanded (i.e. Alternative Benefit Plans) – Medicaid expansion plans offered by states that extend Medicaid eligibility to non-elderly individuals with annual incomes at or below 133 percent of the federal poverty level ($16,040 for an individual or $32,718 for a family of 4 in 2017) are required to cover services without cost-sharing.4,5
  4. Traditional Medicaid plans – Those states that, at their option, cover without cost-sharing in their standard Medicaid benefit package all USPSTF-recommended services that have a Grade “A” or “B” and all ACIP-recommended vaccines receive an increase in their federal medical assistance for such services and vaccines.6

In addition to these services, private and public plans may cover other preventive services without cost-sharing.

Preventive services for TB that may be covered without cost-sharing, pursuant to Affordable Care Act (ACA) requirements.
Preventive Service Recommending Authority
(authorized under Section 1001 of the Patient Protection and Affordable Care Act)
Eligible Populations and Service Specifics Health Insurance Plans That Cover the Service Without Cost-Sharing
Tuberculosis Testing Bright Futures Recommendations for Pediatric Preventive Health Care
(American Academy of Pediatrics, 2017)6
Test adolescents and children <= 21 years of age based on recognition of high-risk factors.7
(See Recommendations for Preventive Pediatric Health CareCdc-pdfExternal for additional information.)
  • Non-grandfathered private health insurance plans
  • Medicaid expansion plans
  • Traditional Medicaid plans
    Optional. In general, preventive services for children are covered Included as part of the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit for children; cost-sharing may apply in some cases.
USPSTF
(Grade "B" recommendation, issued September, 2016)
Screen for latent tuberculosis infection (LTBI) in adult populations at increased risk.8
(See Final Recommendation Statement: Latent Tuberculosis Infection: ScreeningExternal for additional details.)
  • Non-grandfathered private health insurance plans
  • Medicaid expansion plans
  • Traditional Medicaid plans
    Optional as above.
Page last reviewed: May 2, 2018