What Preventive Care Is Free Under Your Health Plan?

On this page

• Where the free preventive care list comes from
• Examples of free preventive care
• When preventive care isn’t free
• Colonoscopies and polyps
• Plans that don’t have to follow the rule
• The Supreme Court case and the Task Force
• Vaccines: recent changes
• Medicare’s preventive services
• How to avoid a surprise bill
• Frequently asked questions

Where the free preventive care list comes from

The ACA requires group health plans and insurers selling individual or group coverage to cover four kinds of preventive care without any cost sharing:

1. Services that the U.S. Preventive Services Task Force rates A or B
2. Vaccines recommended by the CDC’s Advisory Committee on Immunization Practices (ACIP)
3. Preventive care and screenings for infants, children and teens in guidelines supported by the Health Resources and Services Administration (HRSA)
4. Additional preventive care for women in HRSA-supported guidelines

That covers Marketplace plans and most job-based plans. A new recommendation has to be covered starting with the plan year that begins at least one year after it’s issued. KFF estimates that about 100 million privately insured people get preventive services each year without cost sharing. Preventive care is also one of the 10 essential health benefits.

Examples of free preventive care

HealthCare.gov publishes the full lists. A few examples from each:

Adults

• Blood pressure screening, and cholesterol screening at certain ages or higher risk
• Colorectal cancer screening from 45 to 75
• Type 2 diabetes screening from 40 to 70 for people who are overweight or obese
• Hepatitis C screening from 18 to 79, and HIV screening from 15 to 65
• Lung cancer screening from 50 to 80 for people at high risk because of smoking
• Vaccines such as flu, shingles, pneumococcal and tetanus shots

Women

• Well-woman visits
• Mammograms every 1 to 2 years from age 40, and cervical cancer screening from 21 to 65
• FDA-approved birth control, with an exception for certain religious employers; see does health insurance cover birth control
• Breastfeeding support, counseling and supplies
• Bone density screening at 65 and older, or younger after menopause

Children

• Well-baby and well-child visits
• Recommended vaccines from birth to 18
• Newborn hearing and blood screenings
• Autism screening at 18 and 24 months
• Vision screening, and fluoride varnish once teeth come in

When preventive care isn’t free

You go out of network. Plans with a network generally don’t have to cover preventive services from out-of-network providers. The exception is when no one in the network can provide the service.

The care isn’t preventive. Free coverage is for the screening itself. If a test finds something and you need more tests or treatment, normal cost sharing usually applies. A colonoscopy done because you have symptoms is diagnostic, not screening.

The visit is mainly about something else. Under federal rules, the plan can charge for an office visit that’s billed separately from the preventive service, or for a visit whose main purpose isn’t preventive. So bringing up a new health problem at your checkup can turn part of it into a regular visit.

You fall outside the recommendation. The free coverage follows each recommendation’s age, risk and frequency rules, and plans can set reasonable limits where a recommendation doesn’t spell them out.

Colonoscopies and polyps

On ACA plans, if a polyp is removed during a screening colonoscopy, the plan can’t charge cost sharing for the removal, because federal regulators treat it as part of the screening. The lab exam of the polyp and a required pre-procedure consultation are covered without cost sharing too. A follow-up colonoscopy after a positive stool-based test also has to be covered at no cost.

Medicare works differently. A screening colonoscopy is free if your doctor accepts assignment, but if a polyp is removed you pay 15% of the Medicare-approved amount in 2026, plus a 15% facility coinsurance at a hospital outpatient department or surgery center. That drops to 10% for 2027 through 2029, then to zero starting in 2030. See does health insurance cover colonoscopies for the details.

Plans that don’t have to follow the rule

• Grandfathered plans: Individual policies bought on or before March 23, 2010 don’t have to offer free preventive care.
• Short-term plans: They don’t have to cover essential health benefits, and preventive care is one of the things they commonly leave out. See short-term health insurance.
• Health care sharing ministries: They aren’t insurance, so the ACA’s coverage rules don’t apply to them.

The Supreme Court case and the Task Force

In Kennedy v. Braidwood Management, decided June 27, 2025, the Supreme Court ruled 6-3 that Task Force members are inferior officers whose appointment by the HHS secretary is constitutional. That kept the free coverage requirement in place. The ruling also confirmed that the secretary can remove Task Force members at will and has final say over whether recommendations take effect.

Since then, HHS Secretary Robert F. Kennedy Jr. dismissed the Task Force’s two vice chairs in May 2026 and named eight new members on September 17, 2026, after the panel had gone more than a year without meeting. The 16-member panel then met on September 29-30, 2026.

The current A and B recommendations still set what plans must cover. A new recommendation applies to plan years that start at least a year after it’s issued, and if a recommendation is dropped, plans generally have to keep covering it through the end of the current plan year.

Vaccines: recent changes

Under the ACA, plans must cover ACIP-recommended vaccines at no cost, including vaccines recommended through a shared decision between you and your doctor. Federal vaccine recommendations have changed several times since 2025. In March 2026, a federal judge put several of those changes on hold, including a January 2026 change to the childhood vaccine schedule, and the legal fight was still going in October 2026.

AHIP, the insurance industry’s trade group, said in May 2026 that its member plans will keep covering ACIP-recommended vaccines with no cost sharing through the end of 2027. It’s a voluntary pledge, so confirm with your plan. More detail is in does my health insurance cover vaccines.

Medicare’s preventive services

Medicare Part B covers a long list of screenings and shots, including cancer, diabetes and depression screenings and flu, COVID-19, hepatitis B and pneumococcal vaccines. You pay nothing for most of them if your provider accepts assignment.

You also get a “Welcome to Medicare” preventive visit once in your first 12 months of Part B, then a yearly Wellness visit every 12 months. The yearly visit isn’t a routine physical exam. If your doctor adds tests or services during either visit, you may owe coinsurance and the Part B deductible. For who qualifies, see who is eligible for Medicare.

How to avoid a surprise bill

1. Use in-network doctors, labs and facilities, including the anesthesia provider for a colonoscopy.
2. When you book, say the visit is for a routine screening or checkup, and ask whether it will be billed as preventive.
3. If you want to talk about a new problem, ask whether that will be billed as a separate visit.
4. Check your explanation of benefits afterward. Preventive services should show nothing owed. See what is an explanation of benefits.
5. If you’re charged, ask the provider’s billing office whether the visit was coded as preventive. If the plan still won’t pay, file an appeal within 180 days of the denial, and ask for an external review if that fails. See how to appeal a claim denial.

Want a plan that covers preventive care with no cost sharing? Compare plans by ZIP code.

Frequently asked questions

Is an annual physical free?

Well-woman and well-child visits are on the federal list, so they’re free in network. For other adults, the recommended screenings and shots are free, but whether the checkup visit itself costs anything depends on your plan.

Is preventive care free before I meet my deductible?

On most plans, yes. Covered preventive services from in-network providers have no copay, coinsurance or deductible, even if you haven’t met your deductible.

Why did I get a bill for a screening?

Common reasons are an out-of-network provider, a visit billed for another problem, or a test that went beyond the screening. Check your explanation of benefits and ask the provider how the visit was coded.

This article is general information, not medical, insurance or legal advice. Which services are free depends on your age, risk factors, plan and whether the provider is in network. Last reviewed October 2026.