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Preventive Care at No Cost
The ACA rule requiring most plans to cover USPSTF-recommended preventive services at no cost — screenings, vaccines, counseling, and how the benefit works in practice.
Anyone with an ACA-compliant health plan who wants to understand which preventive services are covered without a copay or deductible — and how to ensure they receive the benefit correctly.
One of the most significant consumer protections in the Affordable Care Act is the requirement that most health plans cover certain preventive services at no cost — no copay, no deductible. This means you can get recommended screenings, vaccines, and counseling without paying anything out of pocket at an in-network provider. Understanding how this benefit works in practice — which services qualify, which plans are covered, and how to avoid accidentally triggering cost-sharing — helps you use it effectively.
The legal basis: ACA Section 2713
Section 2713 of the Public Health Service Act, added by the ACA, requires non-grandfathered health plans to cover preventive services without cost-sharing — that is, without deductibles, copays, or coinsurance. The services that qualify come from three authoritative bodies:
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U.S. Preventive Services Task Force (USPSTF): Recommendations with an A or B grade for adults and adolescents. These grades indicate that the evidence strongly supports the net benefit of the service for the described population.
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Advisory Committee on Immunization Practices (ACIP): Vaccines recommended for children, adolescents, and adults by the CDC’s ACIP. This is the source of the childhood immunization schedule.
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Health Resources and Services Administration (HRSA): Guidelines for women’s preventive services (comprehensive preventive care and screenings beyond USPSTF recommendations) and Bright Futures guidelines for pediatric preventive care.
Plans must cover services from all three sources at no cost when provided by an in-network provider.
Examples of covered preventive services
Screenings and tests:
- Blood pressure measurement
- Cholesterol screening
- Colorectal cancer screening (colonoscopy, stool tests, CT colonography at appropriate ages and risk levels)
- Lung cancer screening (low-dose CT) for adults with a significant smoking history
- Breast cancer screening mammography
- Cervical cancer screening (Pap smear, HPV testing)
- Diabetes screening
- Depression screening
- HIV screening
- Hepatitis C screening for adults born between 1945 and 1965 and others at risk
- Sexually transmitted infection screening
Vaccines: All ACIP-recommended vaccines, including influenza, COVID-19 (when recommended), shingles (Zoster), pneumococcal, Tdap (tetanus, diphtheria, pertussis), and others.
Counseling:
- Tobacco cessation counseling and approved cessation medications
- Obesity counseling and referral
- Alcohol misuse counseling
- Healthy eating and weight management counseling for cardiovascular risk
- Preconception and prenatal counseling at defined recommendations
- Preventive medication for cardiovascular risk (statins for eligible patients)
Women’s preventive services:
- Contraception (all FDA-approved methods, though litigation has affected some plan requirements — check with your insurer)
- Breastfeeding support and supplies
- Gestational diabetes screening
- Domestic violence screening and counseling
- Folic acid supplementation for women planning pregnancy
Pediatric preventive services: Well-child visits at defined ages, developmental screening, fluoride supplementation, vision and hearing assessment, and others per Bright Futures guidelines.
Ensuring you receive the no-cost benefit
Several situations can result in cost-sharing even when the service should be free:
Out-of-network providers: The no-cost requirement applies to in-network providers. If you see an out-of-network provider for a preventive service, normal out-of-network cost-sharing will apply. Always verify the provider is in-network before your visit.
Preventive visit that becomes a treatment visit: If you arrive for an annual physical and your provider addresses a specific symptom, complaint, or condition during the same appointment, the provider may bill two separate components — one as preventive (covered at no cost) and one as a diagnostic or treatment encounter (subject to cost-sharing). This is a common source of unexpected bills. If you want your visit to remain purely preventive, tell your provider you are there for a wellness exam only and that you would prefer to schedule any additional concerns at a separate visit.
Grandfathered or short-term plans: Grandfathered health plans (those unchanged since the ACA) and short-term limited-duration health plans are exempt from the preventive services requirement. Verify with your insurer whether your plan is subject to the requirement.
Services not at the USPSTF A/B level: Not all screening tests are covered at no cost — only those with an ACIP, USPSTF A/B, or HRSA recommendation. If your provider recommends a test that is not on the covered list, standard cost-sharing applies.
Using the benefit effectively
Schedule your annual wellness visit with your primary care provider and request any overdue preventive screenings or vaccines at the same time. Confirm in advance that the provider is in-network and that the visit will be billed as a preventive care encounter. Keep a record of what you have received and what the USPSTF schedule recommends for your age, sex, and risk factors.
Key terms
| Term | Plain meaning | Glossary |
|---|---|---|
| Essential benefits | ACA required coverage categories, including preventive services at no cost sharing | → |
| USPSTF | U.S. Preventive Services Task Force — the body whose A and B recommendations must be covered at no cost | → |
| Deductible | The amount you pay before insurance kicks in; preventive services are covered before you meet your deductible | → |
| Network | The set of providers contracted with your plan — the no-cost benefit applies to in-network providers | → |
| ACA | Affordable Care Act — the law establishing the preventive services benefit | → |
Common questions
- What preventive services must be covered at no cost?
- Under the ACA, most health plans must cover services with an A or B rating from the U.S. Preventive Services Task Force (USPSTF), ACIP-recommended vaccines, HRSA-mandated women's preventive services, and HRSA-mandated pediatric preventive services — all at no cost to the patient. This includes screenings for blood pressure, cholesterol, colorectal cancer, diabetes, depression, HIV, and more; vaccines; prenatal care screenings; and contraception.
- Does the no-cost benefit apply before I meet my deductible?
- Yes. That is the essence of the benefit: these preventive services are covered at no cost to you, without applying your deductible or copay, when you see an in-network provider. Even if you have a high-deductible health plan (HDHP) and have not yet met your deductible, recommended preventive services must be provided at no charge.
- What if I see a preventive care provider and receive other services at the same visit?
- If your visit begins as a preventive care visit but includes evaluation or treatment of a specific complaint or condition, part of the visit may be billed as a separate diagnostic or treatment service subject to cost-sharing. This is a common area of confusion — a blood pressure check as part of an annual physical is preventive; a visit to discuss symptoms and adjust blood pressure medication may be treated as a treatment visit. Ask your provider about how they intend to code the visit before it happens.
- Does the no-cost requirement apply to grandfathered plans?
- No. Grandfathered health plans — those that existed before the ACA and have not undergone significant changes — are exempt from the preventive services requirement. If you have a grandfathered plan, verify with your insurer whether your plan includes preventive services coverage.
- What screenings are covered for adults under USPSTF guidelines?
- USPSTF A and B rated recommendations for adults include blood pressure screening, colorectal cancer screening, lung cancer screening for high-risk smokers, breast cancer screening mammography, cervical cancer screening, depression screening, diabetes screening, HIV screening, statin preventive medication for cardiovascular risk, tobacco cessation counseling, alcohol misuse counseling, obesity and weight counseling, and others. The full list is updated periodically — see the USPSTF website for current recommendations.
Sources
Last reviewed: September 2026