Preventive Services

Preventive services refers to preventive care. Insurers now must provide many of these services at no cost.

Preventive care saves lives and improves one's health by identifying illnesses earlier, managing them more effectively, and treating them before they develop into something more serious.

Preventive Services

Screenings & Immunizations

If you have a new health insurance plan beginning on or after September 23, 2010, the plan generally must provide coverage for a range of preventive health services without requiring any cost sharing (copay or coinsurance).

This requirement applies to all private health insurance plans, including individual, small group, large group and self-insured plans. However, grandfathered plans are exempt from this requirement.

Preventive services must be covered without having to pay a copayment or coinsurance or meet your deductible.

♦ This applies only when these services are delivered by a network provider.

What's changed

• In June 2025, the Supreme Court upheld the ACA's free preventive care requirement. That was the good news.

The ruling also confirmed the HHS Secretary controls the expert panel, the U.S. Preventive Services Task Force (USPSTF), that decides which screenings are free. Secretary Robert F. Kennedy Jr. canceled the panel's meetings for more than a year, removed its leaders, and in September 2026 appointed eight new members. Supporters say they're highly qualified. Critics worry the panel will be politicized.

♦ Vaccine recommendations are changing too. For example, the CDC's vaccine advisers ended the long-standing recommendation that all newborns get the hepatitis B vaccine at birth. Health insurers have promised to keep covering recommended vaccines at no cost through the end of 2027. That's a voluntary promise, not the law. Check your plan documents every year at open enrollment.

Preventive services for all adults, women and children

Private health insurance plans generally must provide coverage for a range of preventive health services without requiring any patient cost sharing.

♦ Many providers fail to properly code a lot of these procedures as "preventive." And many insurers incorrectly apply charges to people's deductible. The burden is on you to carefully inspect all Explanation of Benefits (EOBs) and challenge your insurer to review suspect claims.

There are 3 sets of free preventive services. Select the links below to see a list of covered services for each group:

Know before you go

A routine physical or colonoscopy would be covered without cost sharing. But there will be cases where the doctor performs services that go beyond routine. For these, you may have to pay part of the cost in the form of a copay or coinsurance.

Example 1: You have a physical exam and the doctor charges for a second office visit because he or she advised you on a specific health issue. The charge may be warranted because of additional time spent explaining the issue.

But more often than not, the charge is simply a form of upcharging the office uses to increase revenue. They know your physical costs you nothing, so you're not likely to complain about an office copay.

Example 2: You have a physical exam and the doctor orders blood tests for uric acid to monitor your gout. Or a test for vitamin D levels because you have a history of low vitamin D.

These aren't typical preventive tests. They're used to help treat or monitor a specific health condition. Most plans will balk at covering these tests at 100%, but if your doctor codes the reason as preventive and you complain a little, there's a good chance your insurance company will agree to cover them.

Example 3: Colonoscopies done as routine screening are covered at 100%.

But colonoscopies done to evaluate a specific problem may be classified by the doctor as a diagnostic procedure, which is not covered at 100%.

You may go in for a screening colonoscopy and the doctor finds and removes a few polyps. Good news: federal rules say removing polyps during a screening is still part of the screening. So is the anesthesia. You shouldn't owe a copay or coinsurance.

Same goes for a follow-up colonoscopy after a positive stool test like Cologuard.

♦ That doesn't stop billing offices from getting it wrong. Colonoscopies often get coded as diagnostic when they were actually preventive. Read your Explanation of Benefits (EOB), and if you're charged, push for a claims review.

• These rules are for private insurance. Medicare has its own rules for polyp removal.

♦ Colonoscopies are routinely performed in surgical centers or outpatient facilities. It's important to make sure the facility you'll use is in your plan's network, along with the anesthesiologist who will be attending you at the facility.

Don't assume that because the doctor scheduled you at the facility, everyone is in your network. Check first. There have been many cases where the doctor's services for the colonoscopy were covered at 100%, but then the patient was hit with a large bill from the facility or the anesthesiologist because one or both weren't in-network.

Avoid unexpected costs - confirm that all providers are in your network.