One of the most valuable provisions of the Affordable Care Act is the requirement that ACA-compliant health plans cover a defined set of preventive services with no cost-sharing—meaning no copay, no deductible, and no coinsurance. These services are available to you even if you haven't spent a dollar toward your deductible yet. Knowing what's covered can help you take full advantage of care that's already built into your premium.

What "Covered at No Cost" Actually Means

No cost-sharing applies when the service is performed by an in-network provider and billed as preventive. This distinction matters: if you go in for a routine wellness visit and the doctor also treats a separate condition, the visit may be split into preventive (covered at no cost) and diagnostic (subject to normal cost-sharing). Ask your provider upfront to bill the visit as preventive-only if that's your intent.

Preventive Services for Adults

ACA plans are required to cover the following at no cost for adults:

  • Annual wellness exam (preventive physical)
  • Blood pressure screening
  • Cholesterol screening for adults at elevated risk
  • Colorectal cancer screening (colonoscopy, stool tests) for adults over 45
  • Diabetes screening for adults with high blood pressure
  • Lung cancer screening (low-dose CT) for adults 50–80 who are current or recent smokers
  • Depression screening for adults
  • HIV screening for adults 15–65
  • STI counseling for sexually active adults
  • Obesity screening and counseling
  • Tobacco cessation counseling and medication
  • Alcohol use disorder screening
  • Aspirin preventive use counseling for adults at risk
  • Pre-exposure prophylaxis (PrEP) for HIV prevention

Preventive Services for Women

  • Mammography screening (every 1–2 years starting at 40–50, depending on guidelines)
  • Cervical cancer screening (Pap smear, HPV test)
  • Contraception — all FDA-approved methods
  • Breastfeeding support and lactation counseling
  • Domestic violence screening
  • Bone density screening (osteoporosis) for women 65+
  • Gestational diabetes screening during pregnancy
  • Well-woman visits annually

Preventive Services for Children

  • Well-child visits (scheduled series from birth through adolescence)
  • Developmental screening, autism screening
  • Vision and hearing screening
  • All vaccines on the CDC immunization schedule
  • Fluoride supplements for children without fluoridated water
  • Lead screening for children in high-risk areas

Vaccines Covered at No Cost

All vaccines recommended by the Advisory Committee on Immunization Practices (ACIP) are covered at no cost-sharing when given by an in-network provider. This includes:

  • Flu vaccine (annual)
  • COVID-19 vaccines (check current coverage status)
  • Shingles vaccine (Shingrix) for adults 50+
  • Pneumococcal vaccine for adults 65+
  • Hepatitis A and B
  • MMR, Tdap, HPV, and all childhood vaccines
Note for Florida Residents

While ACA rules apply to marketplace plans, grandfathered employer plans may not cover all these services at no cost. If you're on an employer plan, check your summary of benefits to confirm which preventive services are covered with zero cost-sharing.

When a "Preventive" Visit Gets Billed Differently

This is the most common preventive care surprise: you go in for a free annual physical, but because you mention a symptom or the doctor addresses a chronic condition, the insurer splits the visit. The preventive portion is free; the diagnostic portion gets billed normally. To avoid unexpected charges, have a separate appointment for non-preventive concerns whenever possible.

Use What You're Already Paying For

Preventive care is built into your premium. Not using it means you're leaving value on the table. Schedule your annual wellness visit, get your recommended screenings, and stay current on vaccines. If you'd like to review your current coverage or compare plans, use Florida Plan Finder or talk to an advisor.

Frequently Asked Questions

Do preventive services count toward my deductible?
No. Preventive services covered under the ACA's no-cost-sharing requirement do not count toward your deductible because you pay nothing for them. You also don't need to meet your deductible before receiving these services for free.
What if my in-network doctor charges me for a preventive service?
This shouldn't happen for ACA-required preventive services from an in-network provider. If you're charged, first confirm the service is on the ACA's required list and that it was billed as preventive (not diagnostic). Then call your insurer to report the error.
Are preventive colonoscopies really free?
Yes, for routine screening colonoscopies (preventive, not diagnostic). However, if polyps are found and removed during the colonoscopy, some insurers reclassify the procedure as diagnostic and apply cost-sharing. This is a contested issue—some states have enacted laws preventing this reclassification.
Are annual physicals covered at no cost?
Yes, a routine wellness exam (annual physical) is a covered preventive service at no cost. The key is that it must be billed as preventive. If you discuss treatment for existing conditions during the visit, that portion may be billed separately with cost-sharing.
Does this apply to Medicare?
Medicare has its own set of free preventive services, which is similar but not identical to the ACA list. If you're on Medicare, check Medicare.gov for the specific list of covered preventive services.

Licensed Florida Health Insurance Producer

This resource is maintained by a licensed Florida health insurance producer (NPN #21249133). We help Florida residents find ACA marketplace plans, compare coverage options, and enroll in health insurance. Content is informational and not legal or financial advice.

Sources & Further Reading