Quick answer
Most non-grandfathered health plans must cover specified preventive services without a deductible, copay, or coinsurance when the requirements are met. That does not mean every physical, test, or prenatal service is free.
Check the service, not just the appointment name
| Check | Why it matters |
|---|---|
| Recommended service | Coverage follows specified federal recommendations, including age, risk, and frequency criteria. |
| Provider network | No-cost-sharing coverage generally requires in-network care; limited exceptions can apply. |
| Other care at the visit | Evaluation of a symptom, a separate test, or a separately billed office service may have different costs. |
| Plan details | Ask the plan how the particular service and any related visit are covered. |
Follow-up is not automatically diagnostic
Certain follow-up colonoscopies after a positive non-invasive stool-based screening test or direct visualization test are an integral part of preventive colorectal screening under federal guidance. For applicable plans and eligible individuals, they must be covered without cost sharing. Other follow-up services can have different rules, so avoid assuming either that every follow-up is free or that none is preventive.
A practical question for the office and plan
Illustrative example
“I am scheduling a recommended screening with an in-network provider. What is included, and could the visit, lab work, or another service generate a separate charge?”
Tell your clinician about symptoms and concerns. Ask about billing without delaying needed care or leaving out information your clinician needs.
If you receive a bill
- Compare the service and explanation codes on the EOB with the provider’s bill.
- Ask the plan which coverage rule was applied and whether the service met the preventive criteria.
- Ask the provider to review the coding if the record does not match the care provided. A review may or may not change the claim.
Check frequency rules directly; “annual” does not establish the same timing rule for every service.
Sources checked September 19, 2026. General information; your plan and circumstances matter.
HC · preventiveHHS · preventiveCMS · preventive