Women's preventive services guidelines vs the USPSTF
Most of this site follows the USPSTF. For women there is a second federal list. The Affordable Care Act requires most plans to cover, without cost sharing, the extra preventive care for women in guidelines supported by HRSA. (42 U.S.C. 300gg-13) Those Women's Preventive Services Guidelines are developed and updated by the Women's Preventive Services Initiative (WPSI), led by the ACOG Foundation, and take effect when HRSA adopts them. (WPSI)
Side by side
Years are when the WPSI last updated each recommendation, as shown on its pages.
| Service | WPSI (women's guidelines) | USPSTF |
|---|---|---|
| Well-woman visit | At least one preventive visit a year, from adolescence on (WPSI, 2022) | No separate recommendation |
| Mammogram | Start no earlier than 40 and no later than 50; every 1 to 2 years; continue through at least 74, and age alone is not a reason to stop (WPSI, 2024) | Every 2 years at 40 to 74; evidence insufficient at 75 and older (USPSTF, 2024) |
| Cervical | 21 to 65: Pap every 3 years at 21 to 29; from 30, primary HPV test every 5 years preferred, or co-test every 5 years (WPSI, 2022) | 21 to 65: Pap every 3 years, or from 30 an HPV test or co-test every 5 years (USPSTF, 2018) |
| Patient navigation | Help with breast and cervical screening and follow-up, based on need (WPSI) | No recommendation |
| Diabetes after gestational diabetes | Type 2 diabetes screening, ideally within the first year after birth, for women with past gestational diabetes (WPSI, 2023) | Lists past gestational diabetes as a risk factor; main screening at 35 to 70 with overweight (USPSTF, 2021) |
| Intimate partner and domestic violence | Screen adolescent and adult women at least yearly, with intervention services when needed (WPSI, 2024) | Screen women of reproductive age (USPSTF, 2025) |
| Urinary incontinence | Screen women every year (WPSI, 2024) | No recommendation |
| Anxiety | Screen adolescent and adult women, including during pregnancy and after birth (WPSI, 2020) | Adults 64 and younger; evidence insufficient at 65 and older (USPSTF, 2023) |
| HIV | At least once from 15; earlier or repeat testing by risk (WPSI, 2022) | At least once at 15 to 65 (USPSTF, 2019) |
Mammograms: a wider window
The WPSI recommends that women at average risk start mammograms no earlier than 40 and no later than 50, at least every 2 years and as often as every year, through at least 74, and says age alone should not be the reason to stop. It also counts any extra imaging and pathology needed to finish the screening as part of screening. (WPSI, 2024) The USPSTF recommends every 2 years from 40 to 74. (USPSTF, 2024)
Cervical: primary HPV preferred from 30
The WPSI recommends a Pap test every 3 years at 21 to 29, then from 30 to 65 a primary HPV test every 5 years as the preferred option, or a co-test every 5 years; a Pap every 3 years if HPV testing is not available. It says self-collected HPV testing is an appropriate method. (WPSI, 2022) The USPSTF final 2018 statement allows any of the three from 30; its December 2024 draft is not final. (USPSTF, 2018)
Services only the women's guidelines list
- Well-woman visit: at least one a year from adolescence, to deliver the recommended preventive services; it can be spread over several visits. (WPSI, 2022)
- Diabetes after pregnancy: for women who had gestational diabetes and are not pregnant or diagnosed with type 2 diabetes, testing ideally within the first year after birth, and as early as 4 to 6 weeks. (WPSI, 2023)
- Urinary incontinence: asked about every year. (WPSI, 2024)
- Patient navigation for breast and cervical screening and follow-up, such as help with scheduling, transport or language. (WPSI)
The women's guidelines also cover contraception, breastfeeding support, STI counseling and other services outside the scope of this site; see the WPSI site. HealthCare.gov lists the women's preventive services most plans cover at no cost in network. (HealthCare.gov) See also screenings covered by insurance.
This page cites the WPSI's own pages; ask your plan which version of the guidelines it applies. This page is educational only, not medical advice; talk to your doctor.
Questions people ask
Is a well-woman visit covered with no copay?
HealthCare.gov lists well-woman visits among the preventive services for women that most plans cover at no cost when you see an in-network provider. The WPSI recommends at least one a year. (HealthCare.gov) (WPSI, 2022)
Why does my plan cover a yearly mammogram if the USPSTF says every 2 years?
The ACA also requires coverage of the women's guidelines supported by HRSA, and the WPSI recommends a mammogram every 1 to 2 years. Coverage and the best interval for you are separate questions to discuss with your doctor. (42 U.S.C. 300gg-13) (WPSI, 2024) (USPSTF, 2024)
What is the WPSI?
A coalition led by the ACOG Foundation under an agreement with HRSA that develops and updates the Women's Preventive Services Guidelines. When HRSA adopts them, most plans must cover the services without cost sharing. (WPSI) (42 U.S.C. 300gg-13)
Is urinary incontinence screening really a preventive service?
Yes, in the women's guidelines: the WPSI recommends asking women every year whether they leak urine and whether it affects daily life, with further evaluation if needed. The USPSTF has no recommendation on it. (WPSI, 2024)