Free preventive care under your insurance, and why a "free" visit can still produce a bill

The short answer

Most private health plans must cover a set list of preventive services at no cost to you: no copay, coinsurance or deductible, when you use an in-network provider. This includes job-based plans and plans from HealthCare.gov or Covered California, unless a plan is "grandfathered."
The list comes from three places: services graded A or B by the U.S. Preventive Services Task Force, vaccines recommended by the CDC's vaccine advisory committee, and federal guidelines for women and children.
"Free" covers only the preventive part. Bills usually come from a health problem handled at the same visit, a test not on the list for your age or risk, a test done because of symptoms, or an out-of-network doctor or lab.
A June 2025 Supreme Court decision left the rule in place. Medicare and Medi-Cal have their own rules.
If a bill looks wrong, ask the billing office to check the codes, then appeal to your plan.

Which coverage includes free preventive care

Your coverage	Preventive care at no cost?	What to know
Job-based plan, including plans the employer funds itself (self-funded)	Yes, unless grandfathered	Use in-network providers
Plan from HealthCare.gov or Covered California	Yes	Same rule
Grandfathered plan (in place since March 23, 2010, without major changes)	Not required	Plan materials must say it is grandfathered
Short-term health plan	Not required	The federal preventive-care rule does not apply
Original Medicare	Medicare's own list	Most preventive services cost nothing if the provider accepts "assignment" (takes Medicare's approved amount as full payment)
Medicare Advantage	Yes, in network	No copays, coinsurance or deductibles for in-network Medicare-covered preventive services
Medi-Cal	Yes	See the Medi-Cal section

HealthCare.gov itself warns that coverage may vary and $0 is not certain in every case.

What is on the list

Federal law requires most private plans to cover four groups of services without cost sharing:

Services with an A or B grade from the U.S. Preventive Services Task Force, a panel of volunteer experts appointed by the HHS Secretary. Examples: blood pressure screening, colorectal cancer screening for adults 45 to 75, and mammograms every two years for women 40 to 74.
Vaccines recommended by the Advisory Committee on Immunization Practices (ACIP), once the CDC director adopts them and they appear on CDC's immunization schedules.
Care for infants, children and teens in guidelines supported by the Health Resources and Services Administration (HRSA), including well-child visits.
Added care for women in HRSA's guidelines, such as well-woman visits, birth control and diabetes screening during pregnancy.

Many items apply only to certain ages, sexes or risk levels. Lung cancer screening, for example, is listed for adults 50 to 80 with a heavy smoking history who still smoke or quit within the past 15 years.

HealthCare.gov keeps plain-language lists for adults, women and children, but the Task Force's A and B list is the official record, and the two do not always match. For what may be due at your age, see Preventive Screening by Age; for what happens at a checkup, see Adult Preventive Examinations.

Did the 2025 Supreme Court case change anything?

Not for what you pay today. On June 27, 2025, in Kennedy v. Braidwood Management, the Supreme Court ruled 6 to 3 that Task Force members are properly appointed by the Secretary of Health and Human Services (HHS). The challengers had argued the appointments were unconstitutional. Because the Court disagreed, the requirement to cover A- and B-graded services at no cost stays in effect.

The Court also explained that the Secretary can remove Task Force members at any time and can review and block a recommendation before it takes effect. So the list can change, but the rules build in time:

A new recommendation generally must be covered starting with plan years that begin one year after it is issued.
A plan generally must keep covering a service through the end of the plan year, even if the recommendation changes. The exceptions are a downgrade to a "D" grade (recommended against) or a federal safety concern such as a recall.

In California, a 2025 state law, AB 144, requires state-regulated health plans and insurers to cover, with no cost sharing or prior approval, the preventive services federal guidelines recommended as of January 1, 2025, plus vaccines recommended by the California Department of Public Health. It does not reach self-funded job-based plans; your benefits office can tell you which kind you have.

Vaccines. Federal vaccine recommendations have changed several times since mid-2025. In March 2026, a federal judge in Massachusetts put on hold January 2026 changes to the childhood schedule and votes by newly appointed committee members; the government appealed in April 2026. The appeals court heard arguments on October 6, 2026, and had not ruled as of October 26, and CDC canceled all three 2026 committee meetings, citing the litigation. AHIP, a trade group for health insurers, says its member plans will keep covering all ACIP-recommended vaccines with no cost sharing through the end of 2027. That is a voluntary pledge, not a law. Before a shot, ask your plan or pharmacy whether it is free for you. For adult vaccines, see Understanding Immunizations.

Seven reasons a preventive visit can still produce a bill

1. A health problem was handled at the same visit. Plans may charge for an office visit when its main purpose was not preventive, or when the preventive service is billed separately. If your clinician looks into a new symptom, adjusts treatment for a long-term condition or orders tests for a concern, the office may bill a second, problem-focused visit that day, with a copay or deductible. Medicare suggests a separate appointment for specific concerns, so its Wellness visit stays on prevention.

Example (fictional): Marcus, 48, books his yearly checkup and mentions a sore shoulder. The doctor examines it and orders an X-ray. His plan pays for the checkup in full, but the shoulder exam and X-ray are billed separately and count toward his deductible.

That is proper billing when the extra care happened, but you can ask first: "If we deal with something else today, will it be billed separately?"

2. The service is not on the list for you. A test outside the listed age or risk group, or not on any list, can be billed. The Task Force grades PSA testing for prostate cancer in men 55 to 69 as "C," an individual decision, so federal law does not require no-cost coverage, though your plan may still cover it with cost sharing. Extra lab work not on the lists can go toward your deductible.

3. The test was diagnostic, not screening. Screening looks for disease in someone with no signs of it. A diagnostic test looks into a symptom or an abnormal result, and normal cost sharing usually applies. In Medicare, for example, a screening mammogram is free with a provider who accepts assignment, but a diagnostic mammogram costs 20% of the approved amount after the Part B deductible. Some follow-up care now counts as screening:

a colonoscopy after a positive stool-based screening test (see below);
for most private plans starting in 2026, extra imaging (such as MRI or ultrasound) and pathology needed to complete breast cancer screening for women at average risk;
for most private plans starting in 2027, follow-up testing needed to complete cervical cancer screening.

4. Someone involved was out of network. The no-cost rule covers in-network providers, unless the plan has none who can provide the service. Labs and imaging centers count, so ask where your sample or scan is going. If an out-of-network anesthesiologist, pathologist or radiologist treated you at an in-network hospital or surgery center, federal surprise-billing rules generally limit you to your in-network cost sharing; How to read an itemized hospital bill explains these protections.

5. Your plan is not covered by the rule. Grandfathered and short-term plans do not have to offer free preventive care. Check your Summary of Benefits and Coverage.

6. You went more often, or used a different method, than your plan allows. Where a recommendation does not say how often or how, plans may set reasonable limits. Medicare has frequency limits too, such as one screening colonoscopy every 120 months for people not at high risk.

7. The visit was coded incorrectly. A preventive visit entered as a problem visit, or a screening entered with a symptom code, can trigger cost sharing. The billing office can fix this by sending a corrected claim.

Colonoscopy: the most common surprise

Private plans. When a colonoscopy is scheduled as a screening, federal guidance bars cost sharing for the parts integral to it: a required specialist visit beforehand, bowel preparation medicine, anesthesia, removing polyps, and the pathology exam of anything removed. For people in the recommended age range, a colonoscopy to follow up a positive stool-based test (or an abnormal sigmoidoscopy or CT colonography) is also covered without cost sharing, for plan years beginning on or after May 31, 2022.

Medicare. A screening colonoscopy is free with a provider who accepts assignment, including a follow-up colonoscopy after a positive Medicare-covered stool-based or blood-based test. If the doctor removes a polyp or other tissue, you pay 15% of the approved amount in 2026, plus a 15% facility coinsurance at a hospital outpatient department or surgery center; the Part B deductible does not apply. Under federal rules, that coinsurance is set to fall to 10% for 2027 through 2029 and to zero from 2030. For screening choices, see Cervical and Colorectal Cancer Screening for Women.

Medicare: the Wellness visit is not a physical

Medicare covers two prevention visits at no cost with a provider who accepts assignment, and the Part B deductible does not apply:

The "Welcome to Medicare" preventive visit, once within your first 12 months of Part B.
The yearly "Wellness" visit, once every 12 months after that: a review of your history and medicines, routine measurements such as blood pressure, a memory check, and a written plan listing the screenings and vaccines you need.

Medicare says the Wellness visit is not a routine physical exam, and Original Medicare does not cover routine physicals. If the provider adds a physical or other services the benefit does not include, you may owe coinsurance, the deductible or the full price. If you want a head-to-toe exam, ask beforehand what you will owe.

Part B covers shots such as the flu vaccine at no cost with a provider who accepts assignment. Part D drug plans cover other ACIP-recommended adult vaccines, including shingles, RSV and whooping cough, with no copay or deductible; ask your Part D plan where to get them so they are billed correctly. Medicare Advantage plans cannot charge cost sharing for in-network Medicare-covered preventive services; check your plan's materials for extras, such as a yearly physical.

Medi-Cal (California)

Medi-Cal covers Task Force A- and B-graded services and ACIP-recommended vaccines without cost sharing, and members under 21 get regular well-child checkups. Under AB 144, Medi-Cal must also cover vaccines recommended by the California Department of Public Health or major medical groups such as the American Academy of Pediatrics, even when ACIP does not.

A provider who has proof of your Medi-Cal coverage generally may not bill you for covered services, and must tell a debt collector it used to stop collecting for that care. If you get a bill, call the provider and your plan's member services line. If that does not work, the Medi-Cal Managed Care Office of the Ombudsman can help at (888) 452-8609, weekdays 8 a.m. to 5 p.m. For eligibility and upcoming changes, see Medi-Cal in Plain Language.

Questions to ask before a preventive visit

Is this doctor in my network? Are the lab and imaging center in network too?
Is my plan grandfathered?
Is this test free for someone my age and sex, with my risk factors?
For a colonoscopy: will it be billed as a screening, and are the anesthesia provider and facility in network?
At the visit: if we talk about another problem, will that be billed separately?
Is this test screening, or is it to check a symptom?
With Medicare: is today a Wellness visit or a physical, and will anything not be covered?

If you got a bill: how to ask for a correction

Step 1: Gather the papers. Get the Explanation of Benefits (EOB) from your plan, which shows what it paid and what it says you owe, and an itemized bill with billing codes from the provider. How to read an itemized hospital bill walks through both.

Step 2: Check the codes.

Code on the bill	What it usually means
99381 to 99397	A routine preventive visit (Original Medicare does not cover these)
G0402	Medicare's "Welcome to Medicare" visit
G0438 or G0439	Medicare's first or later yearly Wellness visit
99202 to 99205 or 99211 to 99215, with modifier 25	A separate, problem-focused visit on the same day

Step 3: Call the billing office. If the codes do not match what happened, ask them to review the visit notes, send a corrected claim and hold your account while they check.

Example (fictional): After her plan paid for her annual physical, Rosa gets a $165 bill. The itemized bill shows a second office-visit code with modifier 25, but she had only routine questions and a flu shot. She calls billing: "My plan covers this visit as preventive. Can you check the second visit code, send a corrected claim if it's wrong, and hold my account meanwhile?"

Step 4: Call your plan. If the claim was coded as preventive and you were still charged, ask the plan to reprocess it. If it will not, file a written internal appeal; for most private plans you have 180 days from the denial notice. Some denials can then go to independent external review, which you must request within 4 months of the final denial.

Step 5: Get outside help.

California plans regulated by the Department of Managed Health Care (DMHC): file a grievance with your plan first; if it is not resolved in 30 days, or sooner if urgent, call the DMHC Help Center at 1-888-466-2219. Member services can tell you which agency oversees your plan.
California Department of Insurance-regulated insurance: 1-800-927-4357.
Private employer plans anywhere in the U.S.: U.S. Department of Labor benefits advisors, 1-866-444-3272.
Original Medicare: appeal by the date on your Medicare Summary Notice, or call 1-800-MEDICARE (1-800-633-4227; TTY 1-877-486-2048). Medicare Advantage and drug plans must tell you in writing how to appeal.
Medi-Cal: your plan's member services, then the Ombudsman at (888) 452-8609.

If you have no insurance

Community health centers serve everyone, even people who cannot pay, and set fees by income and family size. Search HRSA's Find a Health Center. You may also qualify for Medicaid (Medi-Cal in California), and Marketplace plans from HealthCare.gov or Covered California include the free preventive benefits above.

Correction, October 26, 2026: The vaccine section now gives the appeal's status (argued October 6, 2026; no ruling as of October 26) and CDC's cancellation of its 2026 vaccine committee meetings. Primary sources were added for AB 144 and for Medi-Cal's copay exemption for preventive services and vaccines.

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