Is an annual physical the same as a wellness visit?

Not exactly. An annual wellness visit (AWV) is a specific preventive service covered at no cost. If your doctor addresses non-preventive issues during the visit, those may be billed separately. Tell your doctor you want a preventive wellness visit to help ensure correct billing.

Are vaccines free under the ACA?

Yes. All ACIP-recommended vaccines are covered at no cost on ACA-compliant plans when administered by an in-network provider. This includes flu shots, COVID vaccines, shingles vaccines, and all childhood immunizations.

Preventive Care Covered at No Cost: What the ACA Requires

What Preventive Services Are Free?

Under the Affordable Care Act, all marketplace and most employer health plans must cover certain preventive services at no cost — no copay, no coinsurance, and no deductible. These services are based on recommendations from the US Preventive Services Task Force (USPSTF), the Advisory Committee on Immunization Practices (ACIP), and HRSA. The free services fall into three categories: services for all adults, services for women, and services for children.

Free Services for All Adults

Covered at no cost include: annual wellness visit, blood pressure screening, cholesterol screening (for certain age groups and risk factors), colorectal cancer screening (ages 45-75), depression screening, diabetes screening (type 2, for adults with high blood pressure), hepatitis B and C screening, HIV screening, immunizations (flu, hepatitis A and B, HPV, measles, meningococcal, pneumonia, shingles, tetanus, and others), lung cancer screening (for high-risk adults 50-80), obesity screening and counseling, sexually transmitted infection screening, and tobacco use screening and cessation support.

Important Limitations

Preventive services are only free when provided by an in-network provider and billed as preventive. If a screening reveals a problem and the visit becomes diagnostic, the remaining services may be subject to cost-sharing. For example, if a polyp is found during a colonoscopy, the removal may be billed as a procedure. Ask your provider to bill the service as preventive whenever possible.

How to Ensure You Are Not Charged

Before your appointment, call your insurance company and confirm that the specific service is covered as preventive at no cost. Make sure you use an in-network provider. After the visit, review the bill and EOB — if you are charged for a service that should be free, call your insurance company and ask them to reprocess the claim as preventive.