Preventive care refers to health services designed to prevent illness, detect conditions early, and keep you healthy before problems develop. Under the ACA, all Marketplace plans are required to cover a defined set of preventive services at no cost to you — no copay, no coinsurance, and no deductible — as long as you use an in-network provider.
Covered preventive services include:
The $0 cost-sharing requirement only applies when the visit is coded as preventive. If your doctor addresses a new complaint or orders additional tests during the same visit, those services may be billed separately and subject to your normal cost-sharing.
Preventive care is covered at $0 cost-sharing only when you see an in-network provider and the service is coded as preventive. If you go out-of-network, normal cost-sharing applies. Always confirm with your provider that the visit will be billed as preventive before the appointment.
Not necessarily. If your doctor addresses a health problem or new symptom during the same visit, that portion of the visit is diagnostic — not preventive — and may be subject to your deductible and coinsurance. This is sometimes called a “split bill.” Ask your doctor upfront to keep the visit coded as preventive if that’s your intent.
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