Preventative Care: What Services Are Always Free Under Insurance?

Where the Requirement Stands Now

Non-grandfathered health plans must cover a defined list of preventive services with no copay, no coinsurance and no deductible, under section 2713 of the Public Health Service Act as amended by the ACA.

That requirement was challenged and survived. In Kennedy v. Braidwood Management, decided 27 June 2025 by six votes to three, the Supreme Court held that members of the US Preventive Services Task Force are inferior officers whose appointment by the Secretary of Health and Human Services is constitutional. Around 100 million privately insured people use these services without cost sharing each year, and that continues.

One part of the ruling matters for the future. The Court also confirmed that the Secretary may remove Task Force members at will and may review and block recommendations before they take effect. The requirement is secure; the contents of the list are more politically mutable than they were. The Court did not address separate challenges concerning the immunisation and women's and children's health components.

Practical consequence: check the current list rather than an article, including this one.

Three Bodies Decide What Is Free

""The preventive list"" is actually three lists, which is why coverage questions get confusing.

If a service is not on one of those three lists, no plan is required to cover it at zero cost — which is why a test your doctor considers sensible may still generate a bill.

What Is Actually Covered

All adults: blood pressure screening; cholesterol screening at defined ages and risk levels; type 2 diabetes screening for adults with high blood pressure; obesity screening with intensive behavioural counselling where BMI is 30 or above; depression screening; tobacco use screening and cessation support including counselling and certain medications; alcohol misuse screening and brief counselling; hepatitis and HIV screening at defined ages; routine immunisations.

Cancer screening: colorectal screening from age 45 — by colonoscopy, stool-based testing or other approved methods; mammography at recommended intervals; cervical cancer screening; lung cancer screening for adults meeting age and smoking criteria.

Women specifically: well-woman visits, contraception, breastfeeding support and supplies, gestational diabetes screening, BRCA risk assessment and genetic counselling for women with relevant family history.

Men specifically: one-off abdominal aortic aneurysm screening for men aged 65 to 75 who have ever smoked.

Children: the Bright Futures schedule — developmental and autism screening at defined ages, vision and hearing checks, lead screening where indicated, and the full immunisation schedule including vaccines that would cost hundreds of dollars otherwise.

Certain preventive medications are also covered without cost sharing where recommended for your risk profile — including statins for adults aged 40 to 75 with cardiovascular risk factors, folic acid in pregnancy, and bowel preparation for a screening colonoscopy.

Screening Versus Diagnostic: The Mechanic, Explained Honestly

The same procedure can be billed two ways. A colonoscopy in an asymptomatic adult at the recommended age is screening and free. The same colonoscopy ordered to investigate symptoms is diagnostic, and diagnostic services are subject to your deductible and coinsurance.

You will find advice suggesting you manage this by not raising symptoms during a preventive visit. Do not do that. Withholding clinical information from your doctor to protect a billing code is a bad trade at any price — the whole value of the visit is that the person examining you knows what is going on. If you have noticed a mole, a pain, or anything else, say so.

What you can legitimately do about the billing:

• Ask in advance how a planned service will be coded and what your share would be under each scenario. The billing office can answer this.
• Book a separate appointment for a new problem where it is not urgent — not to conceal it, but because a dedicated visit gets it proper attention and keeps the billing clean.
• Confirm the laboratory is in network before blood is drawn. Doctors' offices use third-party labs, and an out-of-network lab can bill you for a service that would otherwise be free. Ask which lab, and check it.
• Ask about facility fees. A practice inside a hospital building may add a facility charge on top of a free screening. A standalone clinic often does not.
• Present your current insurance card at the draw, even if the office says it is on file. A stale ID number means the lab bills you at the uninsured rate.

Two Protections People Do Not Know They Have

Polyp removal during a screening colonoscopy. Federal guidance clarified that removing a polyp found during a screening does not convert the procedure into a diagnostic one for cost-sharing purposes. If you are billed for this, it is worth challenging.

Follow-up colonoscopy after a positive stool test. Where a non-invasive screening test comes back positive, the follow-up colonoscopy is treated as part of the screening process and must be covered without cost sharing. This closed a gap that used to leave people with large unexpected bills for doing exactly what the screening pathway told them to do.

Both are common billing errors rather than deliberate denials, and both are fixable — see how to appeal.

Where the Zero Stops

Out-of-network providers. The requirement applies to in-network care. An out-of-network provider or lab can bill you in full for a service that would have been free in network. Verify before, not after — see how to check network status.

Grandfathered plans. A small number of older employer plans predating the ACA are exempt from the preventive services requirement entirely. If your plan is one, none of this applies. Ask your benefits administrator.

Tests that are not on the list. Vitamin D, thyroid panels and comprehensive metabolic panels are frequently requested and frequently not required to be free. Ask before agreeing to add-on tests.

Anything after the screening. The screening is free. The treatment that follows a positive result is ordinary covered care, subject to your deductible and coinsurance — see how deductibles and out-of-pocket maximums work.

Timing

Most plans cover one preventive wellness visit per 365 days rather than once per calendar year. Booking at 360 days can produce a rejection. Check whether your plan runs on a calendar year or a rolling twelve months, and diarise accordingly.

Screening intervals are set by the recommendation itself — mammography and colonoscopy intervals differ from annual visits — so an annual physical does not mean everything on the list is available annually.

Two Situations

The lab nobody checked

A patient attends an in-network practice for an annual wellness visit. Blood is drawn in the office and sent to a third-party laboratory that is not in their plan's network.

The visit is free. The lab work generates a bill, because the requirement to cover preventive services at no cost applies to in-network care and the lab was not in network.

One question at the draw — which lab, and are they in my network — would have prevented it. This is among the most common ways a free visit produces a bill.

The screening that was coded correctly

An adult in their mid-forties books a screening colonoscopy at the recommended age, with no symptoms. Two polyps are found and removed.

The procedure remains a screening for cost-sharing purposes, including the polyp removal, and is billed at zero. The patient's share is nothing.

Had the billing arrived showing a deductible applied, the correct response would have been to challenge it rather than pay — this is a documented protection, not a matter of interpretation.

Both are composite illustrations of common patterns, not accounts of specific individuals.

Frequently Asked Questions

Are all blood tests free at my physical?

No. Only screenings on the recommended lists — cholesterol, glucose for those with high blood pressure, certain infectious disease screening. Vitamin D, thyroid and general metabolic panels commonly generate a charge.

Is the flu shot free?

Yes, from an in-network provider or pharmacy, including formulations recommended for older adults.

Can I have more than one free physical a year?

Generally one per 365 days. Check whether your plan uses a calendar year or rolling twelve months.

Are preventive medications free?

Some are, where recommended for your risk profile — statins for adults aged 40 to 75 with risk factors, folic acid in pregnancy, bowel prep for a screening colonoscopy, tobacco cessation medications. You will usually need a prescription for the zero-cost pricing to apply.

What if I am billed for something that should have been free?

Ask the practice to review the coding first, since a corrected claim resolves many of these. If the coding is right and the denial stands, appeal — this is one of the more winnable categories.

Does this apply to Medicare?

Medicare covers a range of preventive services at no cost, including an annual wellness visit, but the list and the rules differ from the ACA requirement described here.

Should I avoid mentioning symptoms to keep the visit free?

No. Tell your doctor everything relevant. Manage the billing by asking how services will be coded and by booking a separate appointment for a new problem, not by editing what your clinician knows.

Could the list change?

Yes. The Supreme Court confirmed the Secretary of Health and Human Services can review and block Task Force recommendations, so the contents can shift. Check the current list before assuming a service is covered.

The Short Version

The no-cost preventive requirement survived its Supreme Court challenge in June 2025 and remains in force for non-grandfathered plans. What changed is that the list itself became more subject to political revision, so it is worth checking rather than assuming.

Three things determine whether your visit is actually free: the provider is in network, the laboratory is in network, and the service is on one of the three recommended lists. The lab is the one people forget, and it is the most common source of a bill after a free visit.

And do not manage your medical record for billing purposes. Tell your doctor what is going on, ask the billing office in advance how it will be coded, and appeal if the coding turns out wrong.

Sources and Editorial Note

The constitutionality of the preventive services requirement was upheld in Kennedy v. Braidwood Management, Inc., No. 24-316, decided 27 June 2025; the decision also confirmed the HHS Secretary's authority to remove Task Force members and to review recommendations before they take effect, and did not address separate challenges regarding immunisation and women's and children's health recommendations — see KFF's analysis. Covered services derive from US Preventive Services Task Force A and B recommendations, Advisory Committee on Immunization Practices schedules, and Health Resources and Services Administration guidelines, under section 2713 of the Public Health Service Act.

Recommendations, ages and intervals are revised over time and the current lists should be checked directly. This article is general information, not medical advice — screening decisions belong with your clinician, and nothing here should influence what you tell your doctor or discourage you from seeking care. Confirm coverage against your own plan documents, and contact your state insurance department or, for a self-funded employer plan, the US Department of Labor with complaints.