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For individuals and families · Licensed in 20 U.S. states

Preventive care and
your health insurance.

Preventive care means the checkups, screenings, and vaccines meant to prevent illness or catch it early. Marketplace plans and many other plans must cover a federal list of these services without a copay or coinsurance, even before you meet the deductible, when you use an in-network provider. The rule has limits, so here's how it works.

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When it costs you nothing

Three conditions behind
a no-cost visit.

Federal rules set out when a preventive service has no cost sharing:

The service is on the list.

Covered services come from federal recommendation lists, such as screenings rated A or B by the U.S. Preventive Services Task Force and recommended vaccines. Treatment for a problem a screening finds is not part of the rule and can carry normal cost sharing.

The provider is in network.

A plan with a network doesn't have to cover these services out of network, and it may charge you if it does. If the network has no provider who can deliver a listed service, the plan must cover it out of network with no cost sharing.

Prevention is the point of the visit.

If a screening is billed separately from the office visit, the plan may charge for the visit but not the screening. If it isn't billed separately and the visit was mainly for something else, like stomach pain, the plan may charge for the visit.

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What the lists include

Examples from HealthCare.gov.

Examples from HealthCare.gov, preventive care for adults and HealthCare.gov, preventive care for children, read October 30, 2026. The lists can change when recommendations change.

For adults: blood pressure, cholesterol, and depression screening; colorectal cancer screening for ages 45 to 75; Type 2 diabetes screening for certain adults 40 to 70; and recommended vaccines such as flu, tetanus, and shingles.
For children: well-baby and well-child visits, vision screening, hearing screening for newborns, developmental screening under age 3, autism screening at 18 and 24 months, and vaccines from birth to 18.
Women have a separate list that adds services such as breastfeeding support and screenings during pregnancy. Our health insurance for women page covers it.
Doses, ages, and who qualifies vary from one service to the next, so check the list for your age and risk.

The federal lists

The federal lists
by the numbers.

Services or service groups on HealthCare.gov's list for all adults.

Items on the list for children, from newborn screenings to well-child visits.

Vaccines named on each of those two lists, with doses and ages that vary.

Counted from HealthCare.gov, preventive care for adults and HealthCare.gov, preventive care for children on October 30, 2026, with each list's vaccines counted as one line. HealthCare.gov says coverage may vary and $0 cost isn't guaranteed in all cases. Rules from 45 CFR 147.130.

Paul DanielsLicensed health advisor · NPN 20986580

Working with Paul

We check who you can see
for preventive care.

Daniels Health Advisors is the independent brokerage Paul Daniels founded, licensed in 20 U.S. states. The federal list sets a floor for ACA plans, but the network decides which doctors you can use for it. We check that your primary care doctor, pediatrician, or OB-GYN is in each plan you compare, and we point out plans that don't follow ACA rules, since those may not cover preventive services the same way. That includes private PPO options. Some private plans ask health questions, and approval is not guaranteed. Some may not cover care for health problems you had before you enrolled.

Bring the names of your family's doctors and the ages of everyone on the plan, so we can match checkups and vaccines to the right lists.

Your doctors checked for preventive visits in each plan
Licensed in 20 U.S. states · Paul Daniels, NPN 20986580 · FL license G065122
You do not pay us for our help. We are paid by the insurance companies when you enroll. Your price for a plan is the same whether you use us or sign up on your own. Commissions can differ by company.

Your first call

Lining up preventive care in three steps.

Tell us who is covered

Ages, doctors, and any risk factors that matter.

We check the networks

Primary care, pediatric, and women's care providers.

Compare the rest

Premiums and cost sharing for care beyond prevention.

Book a 15-minute call

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At your next checkup

Ask how the visit
will be billed.

When you book, say the visit is preventive, such as a yearly checkup or a well-child visit. If you bring up a new problem during that visit, part of it may be billed as a regular office visit, which can carry a copay or count toward your deductible. Tests ordered for a symptom may not count as preventive. After the call you will have:

In-network doctors for each family member
The preventive services that fit your ages
Which plans follow ACA preventive rules
Cost sharing for any follow-up care

A checklist for

Getting preventive care at no cost.

Confirm the doctor and the lab are in your plan's network.
Book the visit as preventive, and ask whether anything planned would be billed separately.
Check the list for your age before you go.
Read your explanation of benefits afterward, and call the plan if a preventive service was charged.

Preventive care questions

Preventive care FAQ.

What is preventive care?

HealthCare.gov describes it as routine health care, including screenings, check-ups, and patient counseling, to prevent illnesses, disease, or other health problems. It is different from care to diagnose or treat a problem you already have.

Is preventive care free with insurance?

Marketplace plans and many other plans must cover listed preventive services without a copay or coinsurance, even before the deductible, when you use an in-network provider. HealthCare.gov notes coverage may vary and $0 cost isn't guaranteed in all cases.

Is a yearly checkup preventive care?

Well-woman and well-child visits are on the federal lists, and many plans treat an adult's yearly checkup as preventive too, so check your plan. If the doctor also treats a new or ongoing problem during the visit, part of it may be billed with normal cost sharing.

Does preventive care include blood work?

Some of it. Tests on the lists, such as cholesterol screening for adults of certain ages or at higher risk, fall under the preventive rules. Tests ordered because of symptoms or to monitor a condition generally aren't, so they can carry cost sharing.

Do short-term or other non-ACA plans cover preventive care?

Not necessarily. The no-cost-sharing rule applies to Marketplace plans and other plans that follow ACA rules. Plans outside those rules set their own benefits, so read what a plan covers before you count on it.

Do I have to wait for open enrollment?

Not for every plan. A private plan (not from the Marketplace) can often be bought any time of year. Some private plans ask health questions, and approval is not guaranteed. Some may not cover care for health problems you had before you enrolled. Marketplace plans, and other plans that follow ACA rules, work differently. As of November 1, 2026, under current law, open enrollment for 2027 plans on HealthCare.gov runs from November 1, 2026, to January 15, 2027. To start coverage January 1, pick a plan by December 15. States that run their own Marketplace may set different dates, so check with your state's Marketplace. A federal appeal about these rules is pending (City of Columbus v. Kennedy, 4th Cir. No. 26-1938; argued October 30, 2026, with no ruling as of November 1, 2026), so confirm the dates before you enroll. Outside open enrollment, you need a special enrollment period, such as one after losing job-based coverage.

Keep your doctors for
checkups and more.

Book a 15-minute call to check your doctors in each plan, or see quotes online.

Book a 15-minute call Get a quote online

By Paul Daniels, licensed insurance agent (NPN 20986580).

Disclaimer

Daniels Health Advisors LLC is an independent brokerage, not a carrier, HealthCare.gov, or CMS. Agent: Paul Daniels, NPN 20986580, Florida license G065122. This page explains preventive care coverage in general. It is not medical advice; ask your doctor which screenings and vaccines are right for you. Coverage varies by plan, so read the plan documents. The counts describe HealthCare.gov lists on the date read, which can change. Tax credits, plans, networks, and prices depend on your state, zip code, income, and household. We never guarantee approval, a doctor, or a price. Not medical, legal, or tax advice.

Preventive care andyour health insurance.

Three conditions behinda no-cost visit.