HARRISBURG, PA — Pennsylvania insurance regulators are shining a bright light on health coverage heading into 2026, releasing a detailed review of women’s health benefits under Affordable Care Act plans while simultaneously warning consumers not to trust letters claiming their local pharmacy is suddenly out of network.
The Pennsylvania Insurance Department’s second annual Affordable Care Act and Qualified Health Plans Summary Report, released December 23, focuses on women’s health services and finds broad, consistent coverage across insurers for many core benefits, alongside notable gaps that could surprise families if they do not check their policies carefully.
State officials said the report is designed to give consumers a clearer picture of what health plans actually cover and how insurers are monitored for compliance with federal and state law.
For plan year 2026, the department found that every insurer offering qualified health plans in Pennsylvania will cover at least one form of each FDA-approved contraception method. All insurers will also cover Opill, the over-the-counter oral contraceptive, without cost-sharing, as well as Zuranolone, the first FDA-approved fast-acting oral treatment for postpartum depression, though some plans may require prior authorization or limit quantities.
Insurers will also universally cover pregnancy and postpartum depression screenings, postpartum depression care for up to one year after birth, and pelvic floor physical therapy, ensuring access to services tied to pregnancy, childbirth, and recovery.
Beyond those core benefits, coverage becomes far less uniform. Doula support will be covered by only 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 insurers, with one limiting coverage to 120 storage bags, while donated human breast milk will be covered by three insurers, often with restrictions such as prior authorization or infant age limits.
Infertility treatment shows the widest variation. Artificial insemination will be covered by eight of nine insurers, typically with cost-sharing. In vitro fertilization, embryo transplant, ovum retrieval, gamete intrafallopian transfer, and zygote intrafallopian transfer will each be covered by only one insurer, often with quantity limits and cost-sharing. Because of these inconsistencies, regulators urged consumers to contact their insurers directly to confirm coverage details before enrolling or seeking care.
Alongside the coverage report, the Insurance Department is investigating complaints from consumers who received letters stating that their trusted local pharmacies were no longer in their insurance networks. Regulators said some of those notices were sent in error, later followed by correction letters confirming the pharmacies remained in network.
Insurance Commissioner Michael Humphreys urged residents not to assume such letters are accurate. Consumers are advised to call their insurance company or pharmacy benefits manager directly to verify network status, particularly before switching pharmacies or interrupting medication routines.
The department emphasized that community and independent pharmacies play a critical role in health care access, especially for seniors and residents of rural or underserved areas, and said inaccurate information can disrupt care and harm local providers.
Pennsylvanians with questions about their insurance coverage, health plans, denied claims, or pharmacy network status can visit https://www.pa.gov/consumer or call 1-866-PA-COMPLAINT (1-866-722-6675).
Additional information about the Insurance Department’s oversight and consumer resources is available at https://www.pa.gov/agencies/insurance.
For general consumer assistance and complaints, help is also available by phone at 1-866-PA-COMPLAINT (1-866-722-6675).
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