Where the list comes from
The ACA doesn't have a single master list of free preventive services written into the law. Instead, it points to recommendations from three expert groups, and whatever those groups recommend automatically becomes a covered service:
- U.S. Preventive Services Task Force (USPSTF): Screenings and counseling services rated "A" or "B," meaning there's strong evidence they work. This covers most cancer screenings, blood pressure checks, cholesterol tests, and depression screenings.
- Advisory Committee on Immunization Practices (ACIP): All vaccines recommended by the CDC's immunization advisory committee. Flu shots, COVID-19 vaccines, HPV, shingles, Tdap, and others.
- Health Resources and Services Administration (HRSA): Additional guidelines for women's preventive services and children's/adolescent care that aren't covered by the USPSTF.
When these groups update their recommendations, plans must incorporate the changes starting in the plan year that begins at least one year later. So a recommendation issued in March 2025 would be required starting with plan years beginning in 2026 or later.
Screenings covered at $0
These are the major screenings currently required at no cost. Age ranges and frequency vary by recommendation:
- Blood pressure: Adults 18 and older, at every routine visit
- Cholesterol (lipid panel): Adults at increased cardiovascular risk; men 35+, women 45+ (or younger with risk factors)
- Type 2 diabetes: Adults 35-70 who are overweight or obese
- Colorectal cancer: Adults 45-75 via colonoscopy, stool tests (FIT, FIT-DNA), or other approved methods
- Breast cancer (mammography): Women 40-74, at least every other year (with HRSA guidelines now recommending annual screening beginning as early as age 40)
- Cervical cancer (Pap smear/HPV test): Women 21-65 every 3 years (cytology) or every 5 years with HPV testing for ages 30-65
- Lung cancer: Adults 50-80 who have a 20 pack-year smoking history and currently smoke or quit within the last 15 years, annual low-dose CT scan
- Depression: All adults, including pregnant and postpartum women
- Anxiety: Adults under 65
- Hepatitis B and C: Various age groups depending on risk factors; universal Hepatitis C screening for adults 18-79
- HIV: Everyone 15-65, and younger or older adults at increased risk
- STIs (chlamydia, gonorrhea, syphilis): Sexually active women under 25, and others at increased risk
- Osteoporosis: Women 65 and older, or younger postmenopausal women with risk factors
Vaccines covered at $0
Every vaccine recommended by the ACIP is covered without cost-sharing when administered by an in-network provider. The current schedule for adults includes:
- Influenza (flu): Annually for all adults
- COVID-19: Per current CDC recommendations
- Tdap/Td: One dose of Tdap for all adults; Td booster every 10 years
- HPV: Adults through age 26 (shared decision-making for ages 27-45)
- Shingles (Shingrix): Adults 50 and older, two doses
- Pneumococcal (PCV20 or PCV15+PPSV23): Adults 65 and older, or younger adults with certain risk factors
- Hepatitis A and B: Based on risk factors and age
- RSV: Adults 75 and older, or 60-74 with increased risk; also pregnant individuals at 32-36 weeks during RSV season
- Meningococcal: Based on risk factors
- MMR, varicella: If not previously vaccinated
Important: the vaccine itself is free, but it must be administered by an in-network provider or pharmacy. If you walk into an out-of-network pharmacy for a flu shot, your plan may not cover it at $0.
Counseling and behavioral services
- Tobacco cessation: Counseling and FDA-approved cessation medications (patches, gum, prescriptions) for all adults who use tobacco
- Alcohol misuse screening and counseling: All adults
- Healthy diet counseling: Adults at increased cardiovascular risk
- Obesity screening and counseling: All adults with a BMI of 30 or higher
- Fall prevention counseling: Adults 65 and older
- PrEP (HIV pre-exposure prophylaxis): The medication and required lab work for adults at increased risk of HIV, at $0
- Statin therapy: For adults 40-75 at increased cardiovascular risk, the preventive medication itself is covered
Women's preventive services
In addition to the screenings listed above, HRSA guidelines require coverage for these women's health services at $0:
- Contraception: All FDA-approved contraceptive methods, including IUDs, implants, pills, patches, rings, and sterilization procedures. Includes related counseling. Plans must cover at least one form of each type at $0, though they may require cost-sharing for brand-name versions when a generic is available.
- Breastfeeding support: Lactation counseling and breast pump rentals/purchases during pregnancy and postpartum
- Well-woman visits: Annual visits for preventive care and counseling
- Screening for intimate partner violence: Screening and counseling for all women
- Supplementary breast imaging: Starting with plan years in 2026, plans must cover additional breast imaging and pathology services when needed for screening, plus patient navigation services
- Gestational diabetes screening: Pregnant women after 24 weeks
- BRCA counseling: Genetic counseling and testing for women with a family history of breast, ovarian, tubal, or peritoneal cancer
Children and adolescents
For kids, the list is even longer. It includes all of the above vaccines, plus:
- Well-child visits from birth through age 21 (the schedule is more frequent for infants: at birth, 3-5 days, and then at 1, 2, 4, 6, 9, 12, 15, 18, 24, and 30 months, then annually)
- Developmental and autism screening at 9, 18, and 30 months
- Vision screening for children
- Hearing screening for newborns
- Lead screening at 12 and 24 months for at-risk children
- Fluoride varnish for children through age 5
- Depression screening for adolescents 12 and older
- Obesity screening and counseling for children 6 and older
The two catches
Free preventive care sounds straightforward, but two conditions trip people up constantly.
Catch #1: You must use an in-network provider
The $0 cost-sharing requirement only applies when you get preventive services from an in-network provider. Go to an out-of-network doctor for the same screening, and your plan can charge you the full cost. This catches people who go to convenient urgent care clinics or labs without checking network status first.
Catch #2: The visit must be coded as preventive, not diagnostic
This is the bigger problem. The same test can be "preventive" or "diagnostic" depending on why it was ordered. A colonoscopy at age 50 with no symptoms? Preventive. $0. A colonoscopy because you've been having digestive problems? Diagnostic. Subject to your deductible and coinsurance.
The medical procedure is identical. The only difference is the billing code. And the coding decision is made by the doctor, not by you.
Confusing situations that come up all the time
Your screening colonoscopy finds a polyp. You went in for a routine screening, but the doctor found and removed a polyp. Is it still free? Yes. Federal guidance from HHS is clear: polyp removal during a screening colonoscopy is considered an integral part of the screening. The plan cannot reclassify the procedure as diagnostic and charge you cost-sharing. The pathology analysis of the polyp is also covered. If you get billed for this, dispute it.
You mention a symptom during your annual physical. You go in for your free annual wellness visit, and you mention that your knee has been hurting. Your doctor examines the knee and orders an X-ray. That examination and X-ray can be billed as a separate diagnostic visit, on top of the free preventive visit. Some doctors will code the entire visit as preventive to spare you the charge. Others will split the visit into two parts: the preventive wellness exam ($0) and the knee evaluation (billed to you). This varies by practice. If you want to avoid this, some patients save symptom discussions for a separate appointment, though that's not always practical.
Your doctor orders a follow-up test after a screening. Say your mammogram shows something unclear and you need a diagnostic mammogram or ultrasound to follow up. That follow-up is typically classified as diagnostic, not preventive, and will be subject to your deductible. However, starting with 2026 plan years, HRSA guidelines now require plans to cover supplementary breast imaging needed as part of screening at no cost. This is a recent change worth knowing about.
You get a preventive service at the wrong interval. Colonoscopies are recommended every 10 years for average-risk adults. If you get one at year 8 because your doctor recommends it, the plan may treat it as diagnostic. The free coverage is tied to the recommended screening schedule.
How to protect yourself
- Confirm the visit is coded as preventive. When scheduling, explicitly tell the office you want a "preventive" or "wellness" visit. Ask them to confirm which billing code they'll use.
- Verify your provider is in-network. Even if the service is preventive, going out of network means you can be charged. Double-check with both the provider and your insurer.
- Be aware of what you discuss during wellness visits. This isn't to say you should hide symptoms from your doctor. But know that bringing up a new problem may result in a separate charge. Some doctors will note it and schedule a follow-up rather than billing two visits on the same day.
- Review your EOB. After any preventive visit, check that the Explanation of Benefits shows $0 for your cost-sharing. If you see a charge, call your insurer and ask why the service wasn't classified as preventive.
- Appeal incorrect coding. If a legitimately preventive service gets coded as diagnostic, you can ask your doctor's office to resubmit the claim with the correct code. If that doesn't work, file an appeal with your insurer.