General
When the ACA rule is your best friend (Section 2713)
Last reviewed July 1, 2026
Section 2713 of the Affordable Care Act is the single most useful legal foundation for cancer screening access. It requires all ACA-compliant plans to cover — at 100%, with no cost-sharing — every preventive service rated Grade A or B by the U.S. Preventive Services Task Force (USPSTF). That covers most cancer screenings across the lifespan. Knowing the exact language of the rule turns most denials into administrative errors.
The steps
Memorize this sentence for phone calls: "Under ACA Section 2713, my plan is required to cover USPSTF Grade A and B preventive services without cost-sharing. This is a covered service — please reprocess the claim." That specific language, cited by claim number, resolves the vast majority of "I got charged for a screening" issues.
What’s Grade A/B for cancer screening as of 2026: mammogram (biennial, women 40-74); colonoscopy or equivalent (adults 45-75); Pap smear/HPV testing (women 21-65); low-dose CT lung screening (specific age/smoking criteria); PSA (Grade C — shared decision-making, may or may not be covered without cost-sharing depending on plan interpretation); skin cancer screening (Grade I — insufficient evidence, not automatically covered but often covered as part of preventive dermatology).
What’s NOT covered under Section 2713: diagnostic imaging (that’s not preventive), most cancer treatment (that’s not preventive), genetic testing UNLESS you meet criteria (see genetic testing guide), and supplemental imaging (mostly state-law territory).
This applies when
- You have any ACA-compliant health insurance (most plans since 2014)
- You’re getting a service rated USPSTF Grade A or B
- The service is being coded as preventive/screening (not diagnostic)
This doesn't apply when
- You have a "grandfathered" pre-ACA plan (rare, but possible — check plan documents)
- The service is diagnostic (has symptoms triggering it, or is a follow-up to abnormal results)
- The service is Grade C, D, or I (Grade C is shared decision-making; D means not recommended; I means insufficient evidence)
Resources
USPSTF recommendations: uspreventiveservicestaskforce.org — search any service to check its grade.
HealthCare.gov preventive services list: healthcare.gov/coverage/preventive-care-benefits. The official list of ACA-covered preventive services.
Centers for Medicare & Medicaid Services (CMS): cms.gov — for Medicare-specific preventive coverage questions.
National Association of Insurance Commissioners: naic.org — state insurance commissioner directory for filing complaints.
If you're denied
If you’re billed for what should be a covered preventive service: (1) call the insurer and cite Section 2713 with the specific USPSTF service grade; (2) if unresolved, file a written appeal; (3) if still denied, request an external review; (4) if still denied, file a complaint with your state insurance commissioner. This ladder resolves the vast majority of screening billing errors.
