Last reviewed: 7 October 2026

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Preventive services at no cost to you: what the ACA statute, the federal rule and HealthCare.gov say

The short answer: section 2713 of the Public Health Service Act, 42 U.S.C. 300gg-13, says a group health plan or a health insurer offering group or individual coverage must cover four kinds of preventive services and must not impose any cost-sharing requirements for them, subject to the exemptions described below.^[1] The rule that carries it out, 45 CFR 147.130, names copayments, coinsurance and deductibles as the cost sharing that cannot be charged, and adds rules for office visits, out-of-network providers and timing.^[2] HealthCare.gov says these services are generally covered at no cost when an in-network provider delivers them, and that $0 is not guaranteed in all cases.^[3] This page describes the rules. It does not list which services qualify today and does not rate any plan.

The short version

• The statute lists four categories: services rated A or B by the U.S. Preventive Services Task Force, immunizations recommended by the CDC's Advisory Committee on Immunization Practices, preventive care and screenings for infants, children and adolescents in guidelines supported by the Health Resources and Services Administration (HRSA), and additional preventive care and screenings for women in HRSA-supported guidelines.^[1]
• The rule says a plan or issuer may not charge a copayment, coinsurance or a deductible for them.^[2]
• An office visit can still carry cost sharing in some cases, depending on how it is billed and what its primary purpose was.^[2]
• The rule says these requirements do not apply to grandfathered health plans.^[2]
• The women's-preventive-services requirement is subject to exemptions for certain religious and moral objectors from the contraceptive-coverage requirement, in 45 CFR 147.132 and 147.133.^[2][6][7]
• HealthCare.gov links to separate lists of covered services for all adults, for women and for children.^[3]

The four categories in the statute

The statute also says nothing in the subsection stops a plan from covering services beyond those recommended, or from denying coverage for services the Task Force does not recommend.^[1] The regulation adds that, for immunizations, the rule covers those for routine use in children, adolescents and adults, and treats a recommendation as in effect once the CDC Director has adopted it.^[2] The statute and rule also say the November 2009 Task Force breast cancer screening recommendations are not treated as current.^[1][2]

How an office visit is treated

Section 147.130(a)(2) sets three rules for the visit at which the service is delivered:^[2]

The rule's own examples: a cholesterol screening billed separately from the visit cannot carry cost sharing, but the office visit can; a blood pressure screening during a visit about recurring abdominal pain, billed only as an office visit, can carry the visit's cost sharing; and a child's annual physical that follows the HRSA guidelines, billed as one office visit, cannot.^[2]

Other rules in 45 CFR 147.130

• Out-of-network providers. A plan with a network need not cover these services from an out-of-network provider, and may charge cost sharing for them. If the plan has no in-network provider who can deliver the service, it must cover the service out of network and may not charge cost sharing.^[2]
• Medical management. A plan may use reasonable medical management to decide frequency, method, treatment or setting, to the extent the recommendation or guideline does not specify.^[2]
• Treatment that follows a screening. A plan may charge cost sharing for a treatment not described in the recommendations, even if it results from a covered preventive service. The rule's example: a cholesterol screening that leads to a diagnosis and a prescribed treatment.^[2]
• Timing. Coverage is required for plan years beginning one year or more after a recommendation or guideline is issued. If a plan must cover a service on the first day of a plan year, it must cover it through the last day of that year even if the recommendation changes, except when a recommendation is downgraded to D or the item or service is subject to a safety recall or a significant safety concern.^[2]
• Grandfathered plans. The rule says these requirements do not apply to grandfathered health plans and points to 45 CFR 147.140. HealthCare.gov defines a grandfathered plan, for the individual market, as a policy purchased on or before March 23, 2010.^[2][4]
• Exemptions and accommodation. The women's-preventive-services requirement is subject to 45 CFR 147.131 to 147.133, which exempt certain religious and moral objectors from the HRSA contraceptive-coverage requirement and set an optional accommodation process.^[2][5][6][7]

What HealthCare.gov says

HealthCare.gov says most health plans must cover a set of preventive services, such as screening tests, at no cost to you, including plans in the Marketplace. It adds that in most cases you will not pay a copayment or coinsurance for certain preventive services like immunizations and screening tests, even if you have not met your deductible, that coverage may vary, and that $0 cost is not guaranteed in all cases.^[3]

How to verify this yourself

The statute, the rule and the HealthCare.gov lists for adults, women and children are linked in the references. A plan's own preventive-services list comes from the plan.

What this page does not cover

We do not list which services are currently rated A or B, recommended or in the guidelines, because those lists change. We do not cover who qualifies for the 45 CFR 147.132 and 147.133 exemptions or the accommodation procedure in 147.131, the rule's COVID-19 preventive service provisions (which the rule says do not apply to services furnished on or after the expiration of the COVID-19 public health emergency, 147.130(e)), state preventive-care mandates, Medicare's preventive benefits, or whether any particular bill was charged correctly. We do not rate any plan. This is general information, not insurance, tax or legal advice. For your own situation, ask your agent or insurer, or contact your state or provincial insurance regulator.

Your next step

A plan can say whether a specific service is on its no-cost preventive list, how a provider will bill the visit and whether the provider is in network, and can explain a charge in writing on request.

Related checks

Our standard explains how we check an agent's license and disciplinary history. Check an agent reports our findings at category level, as a method and not a verdict. Neither reviews any insurer, plan or product. For what a plan must disclose about your cost sharing, see the Summary of Benefits and Coverage guide. For the other federal protections and which grandfathered plans keep them, see ACA protections and grandfathered plans. For cost-sharing terms, see deductible, copay, coinsurance and out-of-pocket maximum. More plain-language guides are in the agent guides.

When we will update this page

We re-read the sources when they change. If something here is out of date, tell us. Corrections are dated on the page.

References

1. [1] Cornell Law School Legal Information Institute, text of 42 U.S.C. § 300gg-13 (coverage of preventive health services), read 7 October 2026 — law.cornell.edu/uscode/text/42/300gg-13
2. [2] Electronic Code of Federal Regulations, 45 CFR § 147.130 (coverage of preventive health services), read 7 October 2026 — ecfr.gov/current/title-45/section-147.130
3. [3] HealthCare.gov, "Preventive health services", read 7 October 2026 — healthcare.gov/coverage/preventive-care-benefits/
4. [4] HealthCare.gov, "Coverage for pre-existing conditions" (grandfathered plan definition), read 7 October 2026 — healthcare.gov/coverage/pre-existing-conditions/
5. [5] Electronic Code of Federal Regulations, 45 CFR § 147.131 (accommodations in connection with coverage of certain preventive health services), read 7 October 2026 — ecfr.gov/current/title-45/section-147.131
6. [6] Electronic Code of Federal Regulations, 45 CFR § 147.132 (religious exemptions), read 7 October 2026 — ecfr.gov/current/title-45/section-147.132
7. [7] Electronic Code of Federal Regulations, 45 CFR § 147.133 (moral exemptions), read 7 October 2026 — ecfr.gov/current/title-45/section-147.133