Preventive Care:
What's Covered Free Under Your Insurance

One of the most underutilized provisions of the Affordable Care Act is the requirement that most health insurance plans cover a comprehensive list of preventive care services at zero cost-sharing — meaning no deductible, no co-pay, and no co-insurance when you use an in-network provider. This applies to the annual physical exam and extends far beyond it.

The Rule: How ACA Preventive Care Coverage Works

Under the ACA, non-grandfathered health insurance plans (which is most plans sold today) must cover preventive services recommended by:

• The U.S. Preventive Services Task Force (USPSTF) — at Grade A or B ratings
• The Advisory Committee on Immunization Practices (ACIP) — for vaccines
• The Health Resources and Services Administration (HRSA) — for women's health and children's services

Important caveat: These services must be billed as preventive. If your doctor identifies a problem during a preventive visit and addresses it, that part of the visit may be billed as diagnostic (and cost-sharing applies). This distinction trips up many patients — discuss billing with your provider's office before your visit if you're unsure.

Free Preventive Services for All Adults

Screenings

• Blood pressure screening — covered at every preventive visit
• Cholesterol screening — adults at elevated risk
• Type 2 diabetes screening — adults 35–70 with overweight/obesity
• Colorectal cancer screening — adults 45–75 (colonoscopy, stool-based tests)
• Depression screening — all adults
• HIV screening — ages 15–65 and higher-risk individuals
• Hepatitis C screening — all adults 18–79
• Lung cancer screening — adults 50–80 who smoke or have quit within 15 years
• Obesity screening and counseling — adults with BMI 30+
• Alcohol misuse screening and counseling
• Tobacco use screening and cessation counseling

Vaccines (All Adults, Per ACIP Schedule)

• Flu (influenza) — annually
• COVID-19 — per current ACIP guidance
• Tdap / Td (tetanus, diphtheria, pertussis) — booster every 10 years
• Shingles (Shingrix) — ages 50+
• Pneumococcal — ages 65+
• RSV vaccine — ages 60+ (recently added to ACIP schedule)

Free Preventive Services for Women

• Well-woman visits — annually
• Mammography — every 2 years for women 40+
• Cervical cancer screening (Pap smear / HPV test) — per USPSTF recommendations
• BRCA counseling and genetic testing — for women with family history risk factors
• Gestational diabetes screening — during pregnancy
• Folic acid supplementation counseling — women of reproductive age
• All FDA-approved contraceptives — including IUDs and implants
• Breastfeeding support and supplies

Free Preventive Services for Children

• Well-child visits — from birth through age 21
• All ACIP-recommended childhood vaccines
• Vision screening
• Hearing screening
• Developmental and behavioral assessments
• Lead screening
• Depression screening (adolescents 12+)
• Obesity screening and counseling

Maximizing Your Free Preventive Benefits

Schedule Your Annual Wellness Visit

Many of these services are ordered or coordinated at an annual wellness visit. If you haven't had one in the last year, schedule it. For adults 65+, Medicare's Annual Wellness Visit (AWV) covers all of these plus a cognitive health assessment.

Ask About Each Screening's Appropriateness for You

Not all screenings apply to everyone — recommendations vary by age, sex, family history, and risk factors. Ask your doctor: "Are there any recommended preventive screenings I'm overdue for?"

Verify Billing Before You Leave

Ask the front desk: "Will this visit be billed as preventive?" If you discuss a current problem or concern during a preventive visit, the provider may split the billing — the preventive portion at $0 and the diagnostic portion at your regular cost-sharing. Ask upfront how it will be billed.

Use In-Network Providers

Preventive care cost protections apply only to in-network providers. Using an out-of-network provider for a preventive service may result in cost-sharing even for ACA-covered services.