No-Cost Preventive Care: Just the Figures
No-Cost Preventive Care: the whole thing in five minutes, for when you want the numbers and nothing else.
Screenings, vaccines and checkups that most health plans must cover without a copay or coinsurance under the Affordable Care Act.
Key takeaways
- Who must cover it: Marketplace plans and most job-based plans, except some grandfathered plans
- What is included: services recommended by the USPSTF (A or B grade), routine vaccines, and listed services for women and children
- Most useful single change: Check HealthCare.gov's list of covered preventive services for adults, women and children.
- Commonest mistake: Raising new health problems at a preventive visit without asking whether that adds a charge.
- See a doctor if any of the signs under "When to speak to a doctor" below apply to you.
The numbers, in one place
| Measure | Figure |
|---|---|
| Who must cover it | Marketplace plans and most job-based plans, except some grandfathered plans |
| What is included | services recommended by the USPSTF (A or B grade), routine vaccines, and listed services for women and children |
| Cost to you | no copay or coinsurance, even before the deductible, when you use an in-network provider |
| Examples | blood pressure screening, recommended cancer screenings, flu shots, well-child visits |
| Catch | tests or treatment for a problem found during the visit may be billed as diagnostic care |
In one paragraph
Many people skip preventive care because they assume it costs money, when for most plans it is free in network.
Worth doing
- Check HealthCare.gov's list of covered preventive services for adults, women and children
- Tell the office when booking that the visit is a preventive checkup
- Use an in-network provider so the no-cost rule applies
- Ask before extra tests are done whether they will be billed as preventive or diagnostic
Worth avoiding
- Raising new health problems at a preventive visit without asking whether that adds a charge
- Assuming every screening is free at any age; coverage follows the recommended ages and intervals
- Paying a bill for a preventive service without first asking the plan if it was coded correctly
Related topics
- CHIP Coverage for Children: What the Evidence Actually Says (Medicare and Medicaid)
- Sexual Health Services: What Published Guidance Supports (Sexual Health)
- Annual Wellness Visit: What the Evidence Actually Says (Preventive Care)
- What the Guidance Really Says About Men and Health Services (Men's Health)
Where to go next
- Starting Out With No-Cost Preventive Care
- Answers to the Common Questions on No-Cost Preventive Care
- No-Cost Preventive Care — the reference entry
- Health Insurance: The Complete Guide
- What the Guidance Really Says About Open and Special Enrollment
- The Evidence on HSAs and FSAs, Without the Hype
When to speak to a doctor
Do not wait for a preventive visit if you have new or worrying symptoms; see your doctor promptly. Call 911 for chest pain, trouble breathing or signs of stroke.
Where this comes from
- HealthCare.gov — Preventive care benefits for adults
- US Preventive Services Task Force — A and B Recommendations
How this page was put together
Every figure, recommendation and warning above is taken from the guidance named in Where this comes from. Nothing on this page is inferred, summarized or generalized beyond what those bodies publish: where they give a number, it is their number, and where they are silent, so are we. Pages are rebuilt whenever the underlying record changes. Sign-off by a named clinician, where it has happened, is shown at the top of the page along with the date.
Medical disclaimer
This article is general information, not medical advice. It cannot account for your own history, medication or circumstances. Always speak to your doctor, pharmacist or another qualified health professional before making changes that affect your treatment, and never delay seeking medical advice because of something you have read here. In an emergency, call 911.
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