Preventive Care Without Cost-Sharing

Do all health insurance policies have to provide preventive care without a deductible? What is covered?

All health insurance policies that were issued after March 23, 2010, when the health-care law was signed, must provide certain preventive care without being subject to the policy’s deductible or copayments. That requirement applies even for high-deductible policies. Policies issued before that date that haven’t changed significantly (so-called grandfathered policies) are not required to provide preventive care without cost-sharing, although many of them do.

The preventive coverage includes screenings for high blood pressure, high cholesterol for adults with a history of the condition, colorectal cancer for adults over age 50, and Type 2 diabetes for adults with high blood pressure. Women over 40 can get fully covered mammograms every one or two years, depending on their risk factors. You are also entitled to several immunizations, depending on your age, as well as other tests and services, depending on your age and health. Children can receive routine vaccinations, well-baby and well-child visits, and other preventive services. See the preventive-care page at Healthcare.gov for a list of services and eligibility requirements.

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You may still end up with some out-of-pocket expenses for these services if you get follow-up tests or cover other medical issues while at the doctor's office. You may also have to pay extra if you go to an out-of-network provider.

Medicare must now provide certain preventive-care benefits without cost-sharing, too. You can get a “Welcome to Medicare” physical exam within the first year after you sign up for Medicare Part B, and you can get a personalized prevention plan and annual wellness visit. You may also be able to receive screenings for colorectal cancer and high cholesterol without cost sharing, as well as flu shots, pneumonia shots and hepatitis B shots. Women can get mammograms and cervical cancer screening, and men can get certain kinds of prostate screenings. The screenings are fully covered, but you may have to pay for the doctor’s visit. The frequency of the screenings often depends on your age and risk.

See Your Guide to Medicare’s Preventive Services at Medicare.gov for more information.