ACA health insurance
Preventive care on an ACA plan: what is covered without a copay
ACA-compliant plans must cover a list of preventive services, such as many screenings, vaccines and checkups, in network without a copay or deductible. The catch is that the service has to be preventive and the provider in network.
What usually counts
- Annual wellness visits and many screenings.
- Most routine vaccines.
- Certain tests and counseling based on age and risk.
- Contraception and other covered women's preventive services.
The catch
If a visit that starts as preventive turns into treatment for a problem, the treatment part can be billed with cost-sharing. Ask the office how a service will be coded before the visit.
Have this ready when you call
- Your plan's member ID
- Your plan's list of covered preventive services
Common questions
Does this apply to every plan?
It applies to ACA-compliant plans. Short-term plans and some other products work differently.
What if I see an out-of-network provider?
The no-cost rule is for in-network care. Out-of-network care can be billed differently.
Related answers
Rather talk it through?
Call 855-367-1095 and a licensed agent will go through your situation with you. There is no charge to ask, and no obligation to enroll.
- Licensed insurance help
- No guaranteed eligibility, pricing, or availability
- Educational starting point
Information on this site is educational and does not guarantee eligibility, enrollment, pricing, or availability. It is not a recommendation to buy any specific plan or policy.