ACA's Mandate for Free Preventive Care

On June 27, 2025, the U.S. Supreme Court upheld a key component of the Affordable Care Act’s (ACA) preventive care mandate. The Court’s decision requires health plans and health insurance issuers to continue covering, without cost sharing, the full range of recommended preventive care services.

ACA’s Preventive Care Mandate

The ACA requires non-grandfathered health plans and issuers to cover a set of recommended preventive services without imposing cost-sharing requirements, such as deductibles, copayments or coinsurance, when the services are provided by in-network providers. The recommended preventive care services covered by these requirements are:

• Evidence-based items or services with an A or B rating in recommendations of the U.S. Preventive Services Task Force (USPSTF);

• Immunizations for routine use in children, adolescents and adults recommended by the Advisory Committee on Immunization Practices;

• Evidence-informed preventive care and screenings in guidelines supported by the Health Resources and Services Administration (HRSA) for infants, children and adolescents; and

• Other evidence-informed preventive care and screenings in HRSA-supported guidelines for women.

Due to the Court's ruling, the ACA's preventive care mandate remains in full effect and health plans and issuers are required to continue covering the entire range of recommended preventive care services without cost sharing.

Read more HERE

ADA Employment Protections and Retirees

On June 20, 2025, the U.S. Supreme Court issued a decision in Stanley v. City of Sanford, Florida, holding that a former employee does not have the right to sue their former employer under the Americans with Disabilities Act’s (ADA)

antidiscrimination provisions with respect to post-employment benefits.

Background

Title I of the ADA bars employers with 15 or more employees from

discriminating against a qualified individual on the basis of disability in regard to compensation and other matters. The ADA defines a “qualified individual” as an

individual who, with or without reasonable accommodation, can perform the essential functions of the job that the individual holds or desires.

The circuit courts historically disagreed as to whether a former employee who does not hold or desire a job at the time of alleged discrimination is a “qualified

individual” who may sue under the ADA’s discrimination provisions.

On June 20, 2025, the Supreme Court held that former employees may not sue for alleged disability

discrimination that occurred post-retirement.

• The Supreme Court reasoned that former employees are not “qualified individuals” under the ADA because

they do not hold or seek a job.

• The decision resolves a circuit court split and establishes that retirees are not subject to the same ADA protections as employees.

The 11th Circuit reasoned that the ADA only prohibits discrimination against “qualified individuals” who must hold or desire the job at the time of the alleged discrimination.

More details HERE

HHS Revises Cost-sharing Limits

On June 25, 2025, the U.S. Department of Health and Human Services (HHS)

published a final rule to implement new standards for the Affordable Care Act’s (ACA) Marketplaces. This final rule also updates the methodology used for calculating the ACA’s maximum annual limitation on cost sharing. Based on this update, the maximum annual limitation on cost sharing is $10,600 for self-only coverage and $21,200 for family coverage for 2026 plan years. This represents an approximately 15.2% increase from the 2025 limits of $9,200 for self-only

coverage and $18,400 for family coverage.

Highlights

The ACA requires health plans to place annual limits on enrollees’ out-of-pocket spending for EHB.

• This ACA requirement applies to all non-grandfathered health plans.

• HHS annually adjusts the ACA’s cost-sharing limits for

inflation.

• HHS has revised the cost sharing limits for plan years

beginning in 2026.

The ACA requires health plans to apply an embedded out-of-pocket limit for everyone enrolled in coverage. Each enrollee must have an individual out-of-pocket limit on EHBs that is not higher than the ACA's out of pocket maximum for self-only coverage.

Federal Court Modifies HIPAA Privacy Protections

On June 18, 2025, the U.S. District Court for the Northern District of Texas struck down a final rule that was issued in April 2024 to strengthen HIPAA’s privacy protections for reproductive health care. The final rule, which became effective Dec. 23, 2024, prohibits health plans and other regulated entities from using or disclosing protected health information (PHI) related to lawful reproductive health care in certain situations. The Texas decision vacates these new protections in their entirety nationwide.

Highlights

On June 18, 2025, a District Court in Texas struck down a final HIPAA privacy rule on reproductive health care.

• The court ruling is effective nationwide.

• Although the court vacated the special protections for reproductive health care, regulated entities must continue to comply with HIPAA’s general privacy protections and any applicable state privacy laws.

Going forward, regulated entities must still comply with HIPAA’s general privacy requirements for PHI and any applicable state privacy laws. Employers should review the terms of their HIPAA policies to determine if updates should be made to remove the special rules for reproductive health care.