Preventive healthcare refers to medical services designed to prevent illness, catch health problems early, and maintain your overall health, rather than treating conditions after they develop. Under ACA rules, most recommended preventive services are covered at no cost to you on in-network care, meaning no copay and no deductible applies.
This "$0 for preventive care" rule applies to services recommended by the U.S. Preventive Services Task Force (USPSTF) and Advisory Committee on Immunization Practices (ACIP). It does not mean that every visit to your doctor is free. If you go in for a checkup and your doctor also treats or diagnoses a new condition during the same visit, that additional care may be billed separately and subject to your deductible and cost-sharing.
Common preventive services covered at $0 on most ACA plans include:
- Annual wellness visits and physical exams
- Flu shots, COVID vaccines, shingles, HPV, and other recommended vaccinations
- Blood pressure, cholesterol, and diabetes screenings
- Cancer screenings, including mammograms, colonoscopies, and skin checks
- Depression and behavioral health screenings
- Women's health services, including prenatal visits, contraception, and breastfeeding support
- Pediatric checkups and developmental screenings for children
For families, the preventive care coverage is especially valuable for children. Well-child visits, developmental screenings, vision and hearing tests, and recommended childhood vaccines are all covered at $0 as preventive services. This is why keeping up with your children's routine care doesn't have to come with a bill.
One thing to keep in mind: preventive care coverage rules can sometimes vary between plans, and out-of-network providers may not have the same zero-cost rules. When in doubt, confirm with your plan before scheduling.
Want to understand exactly what's covered under your plan at no cost? Call us at (305) 330-1277 or See your plan options.
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