Preventive care services covered at 100%
Under the ACA, most plans cover a long list of preventive services with no copay, no coinsurance, and no deductible — even before you've met it.
Under the Affordable Care Act, most health plans cover a defined set of preventive services at 100% when delivered by an in-network provider. No copay, no coinsurance, and no deductible — these are designed to catch problems early and have been shown to lower long-term medical costs.
Preventive services for all adults
- Annual wellness visit
- Blood pressure, cholesterol, and diabetes (Type 2) screening
- Depression, anxiety, and alcohol misuse screening
- Tobacco cessation counseling and medications
- HIV, hepatitis C, and STI screening (per USPSTF guidelines)
- Adult vaccines per CDC schedule (flu, COVID-19, Tdap, MMR, HPV, shingles, pneumonia)
- Aspirin and statin use counseling for cardiovascular risk
- Colorectal cancer screening starting at age 45 (colonoscopy or stool-based)
- Obesity screening and counseling
Preventive services for women
- Well-woman visits
- Breast cancer screening (mammograms), typically starting at 40
- Cervical cancer screening (Pap smears and HPV testing)
- Contraception (all FDA-approved methods, including IUDs, implants, and sterilization)
- Breastfeeding support, counseling, and equipment (including a breast pump)
- Prenatal screenings including gestational diabetes
- Domestic violence screening and counseling
- BRCA risk assessment and genetic counseling for those at elevated risk
Preventive services for children
- Well-child visits at recommended intervals from birth through age 21
- Childhood vaccines per CDC schedule
- Vision and hearing screening
- Developmental and autism screening
- Lead, anemia, and tuberculin testing
- Fluoride varnish through age 5
- Behavioral and depression screening for adolescents
- Obesity, blood pressure, and cholesterol screening when indicated
FAQ
- What if my doctor codes a routine visit as diagnostic by mistake?
Call the provider's billing office and ask them to review. If a service was preventive in nature but was billed as a problem visit, a recoding can change your bill to $0.
- Does this apply to out-of-network providers?
No — the 100% coverage requirement applies only to in-network providers. Out-of-network preventive services are subject to your normal cost sharing.
- Are non-grandfathered plans different?
Plans that have been continuously in place since before March 2010 (called 'grandfathered' plans) are exempt from the ACA preventive care requirements. Most plans today are not grandfathered, but check your plan documents.