Under the Affordable Care Act, health insurance plans must cover a wide range of preventive services at no cost to you, meaning no copay, no coinsurance, and no deductible. This applies to all Marketplace plans and most employer-sponsored plans. The covered services fall into three broad categories: those for all adults, those specifically for women, and those for children. The specific services are determined by recommendations from the U.S. Preventive Services Task Force and other federal health agencies, and only services that received a high-confidence rating for proven benefit are included.
Screenings Covered for All Adults
The list of no-cost screenings is extensive and covers the most common chronic diseases. Blood pressure screening, cholesterol screening (for certain ages or risk levels), and type 2 diabetes screening for adults 35 to 70 who are overweight or obese are all included. For diabetes screening specifically, “overweight” means a BMI of 25 or higher, though for Asian Americans the threshold is lower at a BMI of 23, reflecting higher diabetes risk in that population.
Cancer screenings make up a significant portion of covered services. Colorectal cancer screening is covered for adults 45 to 75. Lung cancer screening is covered for adults 50 to 80 who are heavy smokers or who quit within the past 15 years. Breast cancer mammography is covered separately under women’s preventive services.
Several screenings target infectious diseases: HIV screening for everyone 15 to 65 (and others at increased risk), hepatitis B screening for high-risk individuals, hepatitis C screening for adults 18 to 79, syphilis screening for higher-risk adults, and tuberculosis screening for certain high-risk adults without symptoms. Depression screening and alcohol misuse screening with counseling are also fully covered.
Counseling and Preventive Medications
The ACA mandate goes beyond simple lab tests and imaging. Several counseling services and even certain medications are covered at no cost. Obesity screening and counseling, diet counseling for adults at higher risk of chronic disease, tobacco use screening with cessation support, and STI prevention counseling for higher-risk adults all qualify.
Two preventive medications stand out. Statin therapy is covered for adults 40 to 75 who are at high risk for cardiovascular disease. PrEP, the HIV prevention medication, is covered for HIV-negative adults at high risk of infection through sex or injection drug use. Fall prevention services, including exercise, physical therapy, and vitamin D supplementation, are covered for adults 65 and older living in a community setting.
Immunizations for Adults
All routinely recommended adult vaccines are covered without cost-sharing. The list includes flu shots, tetanus, shingles, pneumococcal, HPV, hepatitis A, hepatitis B, chickenpox, measles, mumps, rubella, whooping cough, meningococcal, and diphtheria vaccines. The specific doses and recommended ages vary by vaccine, but if your provider administers it according to the standard immunization schedule, it should be covered at zero cost.
Women’s Preventive Services
Women have access to an additional set of covered services. Well-woman visits are covered annually and serve as the gateway to many of these screenings. Breast cancer mammography is covered every one to two years for women 40 and older. The U.S. Preventive Services Task Force updated its guidance to recommend that all women begin screening at age 40, rather than leaving the timing of early screening up to individual discussion with a doctor. Cervical cancer screening with a Pap test is covered for women 21 to 65. Chlamydia screening is covered for younger women and others at higher risk.
Contraception coverage is notably broad. Plans must cover at least one form of contraception in each of 17 FDA-recognized categories, with no cost-sharing. Those categories include hormonal implants, copper and hormonal IUDs, injectable contraceptives, several types of oral contraceptive pills, the patch, vaginal rings, diaphragms, sponges, cervical caps, condoms, spermicides, both types of emergency contraception, and sterilization surgery. If your provider determines a specific product is medically appropriate for you, even one not on the standard formulary, your plan is required to cover it without cost-sharing. The one exception: certain religiously affiliated employers may be exempt from the contraception mandate.
Pregnancy-Related Services
Pregnant women receive a distinct set of covered preventive services. These include gestational diabetes screening at or after 24 weeks, hepatitis B screening at the first prenatal visit, preeclampsia screening and prevention for those with high blood pressure, Rh incompatibility screening, syphilis screening, urinary tract infection screening, and expanded tobacco counseling. Folic acid supplements are covered for women who may become pregnant. After delivery, breastfeeding support, counseling, and access to breastfeeding supplies (such as breast pumps) are covered for nursing mothers. Maternal depression screening is also covered at well-baby visits.
Children and Adolescents
Preventive care for children follows the Bright Futures guidelines developed by the American Academy of Pediatrics and adopted by the federal Health Resources and Services Administration. These guidelines lay out a detailed schedule of well-child visits from birth through adolescence. At each visit, providers track growth, assess physical and emotional health, and administer recommended vaccinations.
Age-specific screenings are built into the schedule. Newborn screening results are verified in early visits. Blood lead level checks happen in early childhood. Cholesterol screening occurs in middle childhood. Adolescents are assessed for STI and HIV risk. All of these services, along with the full childhood immunization schedule, are covered without cost-sharing.
The Preventive vs. Diagnostic Distinction
This is where many people get an unexpected bill. A service is only covered at zero cost when it is coded as preventive, meaning routine and not prompted by symptoms or an existing condition. The moment a screening shifts to diagnostic, your normal deductible and coinsurance kick in.
A colonoscopy is the classic example. If you’re 45 and getting your routine colorectal cancer screening, it’s preventive and fully covered. But if your doctor orders the same procedure because you’ve been having symptoms or need to monitor a known condition, it’s coded as diagnostic, and you’ll owe your usual share of the cost. The same logic applies across all services. A cholesterol test at your annual physical is preventive. A cholesterol test to see if your medication is working is diagnostic. How your doctor codes the visit matters enormously for your bill.
If you’re scheduling a visit that combines routine care with follow-up on an existing issue, your provider may split the coding. The preventive portions remain free, while the diagnostic portions go through your regular insurance benefits. It’s worth asking your provider’s office ahead of time how they plan to code your visit.
Which Plans Must Comply
All plans sold on the ACA Marketplace and most employer-sponsored plans are required to cover these preventive services at no cost. The major exception is grandfathered plans, which are policies purchased on or before March 23, 2010, that haven’t substantially changed their benefits or costs since then. Grandfathered plans are not required to offer free preventive care. Your plan must notify you if it has grandfathered status, and you can also check your Summary of Benefits and Coverage document.
Even on compliant plans, there’s a network caveat. Preventive services are only guaranteed to be free when you use an in-network provider. If you go out of network, your plan can apply cost-sharing unless no in-network provider is available to deliver that specific service. Before scheduling any preventive visit, confirm that your provider is in-network to avoid surprise charges.