ACA-compliant plans must cover a defined list of preventive services, such as screenings, immunizations, and annual wellness visits, with no cost-sharing when received in network. The no-cost rule applies only to services on the recommended preventive list.
Yes, for most plans. Marketplace and most other plans must cover breastfeeding support, counseling, and equipment, including a breast pump, at no cost for as long as you breastfeed. Grandfathered plans are the main exception.
In most cases, yes. Marketplace and most plans must cover FDA-approved contraceptive methods and counseling for women with no copay, coinsurance, or deductible in-network. Certain religious employers are exempt; vasectomies and abortion-inducing drugs are not required.
Common reasons: you used an out-of-network provider, the service was billed separately from the office visit, a screening turned diagnostic, or it was not on the official recommended list. Free preventive care is guaranteed only in specific circumstances.
Possibly. The no-cost preventive rule generally applies only to in-network providers. If your plan has a network and you get preventive care out-of-network, it can charge cost-sharing or may not cover it for free.
The ACA-required preventive services are standardized and must be covered at no cost in-network on all non-grandfathered plans. Plans can differ in extra wellness perks, and out-of-network preventive care may carry cost-sharing.
Yes. ACA plans must cover, at no cost in-network, preventive services recommended for specific ages and sexes, like mammograms and cervical screening for women, and age-based cancer screenings and immunizations.
Under the ACA, most health plans must cover a defined set of preventive services (such as recommended screenings, immunizations, and well visits) at no cost to you (no copay or deductible) when you use an in-network provider.