Shapiro Administration Annual Report Gives Clear Look at Maternal and Women’s Health Services Offered through Health Plan Benefits Across Pennsylvania | Insurance Department |[...]

Harrisburg, PA - The Pennsylvania Insurance Department's (PID) second annual Pennsylvania Affordable Care Act (ACA) and Qualified Health Plans (QHP) Summary Report focused on women's health services and identified both consistent quality coverage across companies as well as opportunities for companies to expand plan benefits. The Shapiro Administration prioritizes strengthening the quality and access to women's health care, and the 2025 report provides data showing that those efforts are working, and Pennsylvania families can feel confident in their health coverage options.

The QHP Summary Report helps consumers understand how PID reviews and analyzes health insurers for compliance with federal and state laws and regulations, monitors benefits offerings, and ensures the health insurance market works fairly for all Pennsylvanians. It also helps make policy benefits more transparent to consumers.

"We're encouraged to see strong, consistent coverage across the market for many maternal and women's health benefits, including for contraception and post-partem depression screening and care, said Pennsylvania Insurance Commissioner Michael Humphreys. "PID remains committed to transparency and helping families understand which services are more universally covered and where coverage may differ across companies. By making this information clear and accessible, Pennsylvanians can make informed decisions about their health care options, and our competitive market can continue to grow and improve."

The report found that, for plan year 2026:

• Every insurer will cover at least one form of each FDA-approved contraception method, ensuring broad access to family planning options;
• Opill, the over-the-counter oral contraceptive pill, will be covered by all insurers without cost-sharing;
• Zuranolone, the first FDA-approved fast-acting oral treatment for postpartum depression, will be covered by every insurer, though some may require prior authorization or apply quantity limits; and
• All insurers will also cover pregnant and postpartum depression screenings, postpartum depression care for up to one year, and pelvic floor physical therapy.

These benefits ensure that women have consistent access to critical services during family planning, pregnancy, postpartum, and beyond. Other maternal and women's health services vary by insurer:

• Doula support will be covered by one of nine insurers;
• Surrogacy-related prenatal, delivery, and postpartum care will be covered by two of nine insurers (excluding agency fees);
• Breast milk storage will be covered by five of the nine insurers, with one applying a limit of 120 storage bags; and
• Donated human breast milk will be covered by three of the nine insurers, often with restrictions such as prior authorization or age limits for infants.

Infertility treatment will also be covered by most insurers, though specific services covered will vary:

• Artificial insemination (ICI) will be covered by eight of nine insurers, with one requiring prior authorization and most applying cost-sharing;
• Embryo transplant will be covered by only one of nine insurers, with cost-sharing applying;
• Facility services for fertilization of a female recipient's own ova will be covered by seven of nine insurers in-network, with cost-sharing applying;
• Gamete intrafallopian transfer (GIFT) will be covered by one of nine insurers, with cost-sharing applying;
• In vitro fertilization (IVF) will be covered by one of nine insurers, subject to quantity limits and cost-sharing;
• Intrauterine insemination (IUI) will be covered by six of nine insurers, with one requiring prior authorization and cost-sharing applying;
• Ovum retrieval will be covered by one of nine insurers, subject to quantity limits and/or cost-sharing;
• Services connected to ICI, IVF, IUI, embryo transplant, ovum retrieval, GIFT, and ZIFT will be covered by five of nine insurers, with prior authorization, quantity limits, and/or cost-sharing applying; and
• Zygote intrafallopian transfer (ZIFT) will be covered by one of nine insurers, with cost-sharing applying.

Because coverage is less consistent for these benefits, Pennsylvanians should contact their insurer to determine if their policies cover these services.

Throughout the year, PID works with insurers to ensure women's health remains a priority and is covered equitably for Pennsylvania consumers. The results found in this year's report are a direct reflection of these efforts and also highlight the Department's commitment to addressing the important coverage issues that matter most to Pennsylvanians.

Pennsylvanians with questions about their insurance, health plan or a denied claim should visit pa.gov/consumer or call 1-866-PA-COMPLAINT (1-866-722-6675).

Consumers looking to learn more about health insurance should visit the Department's dedicated Health Insurance page.

Individuals interested in obtaining health insurance may purchase a QHP on Pennsylvania's health insurance marketplace, Pennie. Those purchasing insurance on Pennie may qualify for tax credits. Pennie's open enrollment period for plan year 2026 is open now through December 31, 2025.

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