All benefits/Health Plan Preventive Care Without Cost Sharing
ENTITLEMENT / HEALTH-PLAN-FREE-PREVENTIVE-CARE
CE
Centers for Medicare & Medicaid Services
Health Plan Preventive Care Without Cost Sharing
Most health plans, including Marketplace plans, must cover a defined set of preventive services without a copayment or coinsurance and before the deductible when the current coverage rules are met.
Person enrolled in a health plan that covers the applicable preventive service without cost sharing
Entitlement facts
Benefit type
Government benefit. A government-funded or administered benefit, service, coverage program, assistance program, or public access route. Taxonomy definition →
What it unlocks
No-cost-sharing access to listed preventive screenings, immunizations, counseling, and services for adults, women, and children through most health insurance plans.
Who qualifies
Person enrolled in a health plan that covers the applicable preventive service without cost sharing
Requirements
The person must be enrolled in a plan subject to the preventive-service requirement and meet the service's age, sex, pregnancy, risk, timing, and other criteria. The service generally must be received from an in-network provider, and coverage can vary.
How to activate
Check the official preventive-service list and the plan's current coverage, confirm that the provider is in network and the visit will be billed as preventive, then schedule the service.
Cost basis
Included with a qualifying relationship. The benefit adds no separate charge, but the user must already have an eligible card, account, insurance plan, library card, membership, employment, or similar relationship that may itself cost money.
Cost and fees
Zero cost is not guaranteed in every case. Grandfathered or otherwise exempt plans, out-of-network care, diagnostic follow-up, services outside the listed criteria, and other care during the visit can create charges.
Geography
US, Plan and provider-network availability
Personalization
Published eligibility is not described as individually targeted.
EVIDENCE / 1 SOURCE
Eligibility is conditional, not guaranteed.
Check the provider's final terms immediately before applying, depositing funds, spending, or changing a paid relationship.
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Personalized
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