On ACA-compliant plans, a specific list of preventive services costs you $0 — no copay, no deductible, even if you haven’t met your deductible yet. The list below is organized by who it applies to. Find your group, then schedule accordingly.
The $0 rule only applies when: (1) the service is from an in-network provider, and (2) the visit is coded as preventive, not diagnostic. If your doctor addresses a symptom during a wellness visit, that portion may be billed separately with cost-sharing.
All Adults
- Blood pressure screening
- Cholesterol screening (adults at elevated risk)
- Colorectal cancer screening starting at age 45 (colonoscopy, stool-based tests)
- Lung cancer screening — low-dose CT for adults 50–80 who smoke or quit within 15 years
- Type 2 diabetes screening (overweight/obese adults 35–70)
- Depression screening
- HIV screening (ages 15–65; all higher-risk adults)
- Alcohol misuse screening and counseling
- Obesity screening and counseling
- Tobacco cessation counseling + FDA-approved quit medications
- Flu shot (annual)
- COVID-19 vaccine (per ACIP schedule)
- Tdap, hepatitis A & B, shingles, pneumococcal (age/risk-based)
Women
- Mammogram — annually starting at age 40
- Cervical cancer screening (Pap smear + HPV co-test per schedule)
- Well-woman visit (annual)
- BRCA genetic counseling and testing for women at elevated hereditary risk
- All FDA-approved contraceptive methods (some religious employer exemptions apply)
- Gestational diabetes screening during pregnancy
- Breastfeeding support and lactation counseling
- Domestic and interpersonal violence screening
- Bone density (DEXA) scan — women 65+, or younger women at elevated fracture risk
Children (Under 18)
- Well-child visits at all AAP-recommended ages (birth through 21)
- Developmental screening (including autism at 18 and 24 months)
- Vision and hearing screening
- Lead screening (children at risk)
- All recommended childhood immunizations per ACIP schedule
- Dental fluoride supplements (where water fluoridation is inadequate)
- Obesity screening and counseling
What Is Preventive Care in Health Insurance?
Preventive care is health care aimed at preventing illness or detecting conditions before symptoms develop. Under the ACA, most marketplace and employer plans must cover a defined set of preventive services at no cost to you — no copay, no coinsurance, and no deductible applies, even if you have not yet met your annual deductible.
This is one of the most valuable and underused benefits in health insurance. Many people skip recommended screenings because they assume there will be a cost. For covered preventive services from an in-network provider, there is no patient cost.
What Preventive Services Are Covered at No Cost?
The ACA's preventive care mandates are based on recommendations from three federal bodies: the U.S. Preventive Services Task Force (USPSTF), the Advisory Committee on Immunization Practices (ACIP), and HRSA guidelines for women and children. Covered services include:
Screenings and checkups for adults:
- Blood pressure screening
- Cholesterol and lipid disorder screening (for adults at higher risk)
- Colorectal cancer screening (colonoscopy, stool tests) starting at age 45
- Lung cancer screening (low-dose CT scan) for high-risk adults aged 50–80 who currently smoke or quit within the past 15 years
- Depression screening for adults
- Diabetes (Type 2) screening for overweight or obese adults aged 35–70
- HIV screening for adults aged 15–65 and higher-risk individuals outside that range
- Osteoporosis screening for women 65+ and younger women at elevated risk
- Obesity screening and counseling
- Tobacco use cessation counseling and FDA-approved cessation medications
- Alcohol misuse screening and counseling
- Aspirin use (in some adults at risk of cardiovascular disease)
Women's preventive services:
- Mammograms (annually starting at age 40, or per updated USPSTF guidelines)
- Cervical cancer screening (Pap smear and HPV testing)
- BRCA-related genetic counseling and testing for women at elevated hereditary risk
- Well-woman visits (annual wellness exam)
- All FDA-approved contraceptive methods (with exceptions for some religious employer exemptions)
- Gestational diabetes screening during pregnancy
- Breastfeeding support and lactation counseling
- Domestic and interpersonal violence screening and counseling
Children's preventive services:
- Routine well-child visits and developmental screenings at all recommended ages
- Vision and hearing screening
- Autism spectrum disorder screening at 18 and 24 months
- Blood lead level screening for children at risk
- All recommended childhood immunizations
Immunizations for adults:
- Annual flu vaccine
- COVID-19 vaccines (per ACIP recommendations)
- Shingles (Zoster) vaccine for adults 50+
- Pneumococcal vaccine for adults 65+
- Tdap (tetanus, diphtheria, pertussis) booster
- HPV vaccine through age 26 (and some adults 27–45 per physician recommendation)
- Hepatitis A and B vaccines for at-risk adults
Important Exceptions: When Preventive Care Is Not Free
The no-cost rule has limitations:
- Out-of-network providers: The no-cost mandate applies to in-network providers. Seeing an out-of-network provider for a preventive service may result in cost-sharing.
- When preventive becomes diagnostic: If a colonoscopy finds and removes a polyp, the service may be reclassified as a diagnostic procedure, which may be subject to cost-sharing. Some states have laws preventing this; check your plan and state rules.
- Grandfathered plans: Employer plans that were in place before March 23, 2010 and have not made significant changes may be exempt from the preventive care mandate. These "grandfathered" plans are rare now but still exist.
How to Access Your Free Preventive Services
Schedule your preventive visit with an in-network primary care provider. Tell the office the purpose is a preventive (wellness) visit. If your provider also addresses a problem or symptom during the visit, that portion of the visit may be billed separately and subject to cost-sharing. Keeping preventive and sick-care visits separate avoids unexpected charges.
Questions about what your plan covers? A licensed broker can walk you through your specific plan's preventive care benefits. Call (713) 575-9904.