Preventive Services

Preventive services usually include routine checkups, screenings, vaccines, and counseling. These services are meant to help prevent illness or find health problems early. They are part of regular health care that focuses on keeping you healthy.

Many preventive services are defined under the Affordable Care Act (ACA) and may be covered at no cost when you use an in-network provider. Examples can include:

• Adult screenings: Cholesterol checks, blood pressure screenings, and certain cancer screenings
• Immunizations: Flu shots, MMR vaccines, and other recommended vaccines
• Women’s preventive care: Well-woman visits, prenatal care, and screenings specific to women’s health
• Children’s preventive care: Well-child visits, vision and hearing screenings, and routine vaccines

Services that are not considered preventive may not be covered at no cost. This can include diagnostic care, extra tests, or treatment for a new symptom or specific health concern. For example, if a preventive visit turns into a discussion about a new issue or requires additional testing, those services may be billed separately. Checking your plan details can help you understand what is covered as preventive care and what may lead to additional costs.

Not always. Many covered preventive services are available at no cost when you use an in-network provider. But extra tests, treatment, or follow-up care may lead to other costs depending on your plan.

Preventive services are usually recommended on a regular schedule based on your age, health history, and risk factors. Many people get them during an annual checkup, but some screenings and vaccines may be needed more or less often. Your primary care provider can help you understand what preventive services you need and when to schedule them. Staying up to date with recommended care can help catch health issues early and support long-term health.

No. A preventive visit is for routine care, screenings, and wellness. A sick visit is for symptoms, illness, or a specific health concern. The type of visit can affect how the appointment is billed.

Usually, yes, if you want the best coverage under your plan. Many plans cover preventive services at no cost only when you use an in-network provider. Using an out-of-network provider may lead to higher costs.

You may get a bill if part of the visit was billed as diagnostic care or if you received extra services. For example, discussing a new health concern or needing additional tests can change how the visit is billed. Checking your plan details can help you understand what was covered as preventive care.