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Hesitating to schedule a checkup or tetanus shot due to cost concerns? Here's some uplifting news. Most preventive care services are fully covered, even if your deductible hasn't been met, ensuring you pay nothing out of pocket.
How Health Insurance Deductibles Differ From Common Misconceptions
Health insurance deductibles operate quite differently compared to car insurance deductibles. While auto insurance requires you to pay a set amount before coverage begins, health insurance often covers preventive services without requiring you to meet your deductible first. For instance, if your headlight gets damaged, you'd pay for repairs yourself, as involving your auto insurer wouldn't help. Many hope to avoid using auto insurance altogether, especially if they're cautious drivers. However, health insurance is designed to support your well-being proactively.
However, it’s impractical to assume you’ll never need health insurance. Nearly everyone requires some form of medical attention, even if it’s just a routine checkup. There are two key reasons why seeking care, even with a high deductible, isn’t as expensive as you might believe:
Insurance companies often secure lower rates than what you’d pay out-of-pocket. For example, an office visit might cost $250, but the negotiated rate could be $100. You’re responsible for the $100, while the remaining $150 simply vanishes.
Additionally, federal law mandates that most insurance plans cover specific preventive services at no cost to you. This means no copays, coinsurance, or deductible fees—truly free.
Of course, nothing is entirely free; the cost is factored into your premium. This means your plan already accounts for that checkup, whether you use it or not—so don’t let cost be a reason to delay.
Services You Can Access Without Paying Out-of-Pocket
Here’s a snapshot of what’s available at no cost, provided you visit an in-network provider. Generally, checkups are free: adults are entitled to one annual physical without charge, and as outlined below, well-child visits and annual gynecological exams for women are also fully covered.
An important note: Certain insurance plans are classified as grandfathered and are not required to provide the following benefits for free. (They may still cover them, but this depends on the plan.) Grandfathered plans are gradually declining, but as of 2015, 25 percent of individuals with employer-sponsored health insurance—approximately 11 percent of Americans—still had such plans, according to a Kaiser Family Foundation survey.
A plan that is not grandfathered overall might still be considered grandfathered for specific items marked with a star on the women’s health care list below. This is because these recommendations were introduced later and have their own grandfathering date. If the plan’s website doesn’t clarify whether your plan is grandfathered or if the care you need is fully covered, contact the number on your insurance card for clarification.
Here’s the list of no-cost services, directly from the Department of Health and Human Services (lightly edited for clarity):
For Children
Alcohol and Drug Use evaluations for teenagers
Autism screening for children at 18 and 24 months
Behavioral evaluations
Blood Pressure checks
Cervical Dysplasia screening for sexually active females
Congenital Hypothyroidism screening for newborns
Depression screening for teenagers
Developmental screening for children under 3, with ongoing monitoring throughout childhood
Dyslipidemia screening for children at higher risk of lipid disorders
Fluoride supplements for children without fluoride in their water (ages 6 months to 5 years)
Gonorrhea preventive eye medication for all newborns
Hearing tests for all newborns
Height, Weight, and Body Mass Index measurements
Hematocrit or Hemoglobin screening for children
Hemoglobinopathies or sickle cell screening for newborns
HIV screening for higher-risk adolescents
Immunization vaccines for children from birth to 18 years—doses, recommended ages, and populations vary:
Diphtheria, Tetanus, Pertussis
Haemophilus influenzae type b
Hepatitis A
Hepatitis B
Human Papillomavirus
Inactivated Poliovirus
Influenza (Flu Shot)
Measles, Mumps, Rubella
Meningococcal
Pneumococcal
Rotavirus
Varicella (chicken pox)
Iron supplements for children aged 6 to 12 months at risk of anemia
Lead screening for children potentially exposed to lead
Medical History tracking for all children as they grow (the part of the visit involving detailed questioning)
Obesity screening and guidance
Oral Health risk evaluation for children up to age 10
Phenylketonuria (PKU) screening for newborns to detect this genetic condition
Sexually Transmitted Infection (STI) prevention counseling and screening for higher-risk adolescents
Tuberculin testing for children at increased risk of tuberculosis
Vision screening for all children
For Women
Items marked with a star in this list are newer recommendations, and some plans may not cover them (refer to the details above).
Anemia routine screening for pregnant women
Bacteriuria screening for urinary tract or other infections in pregnant women
* Birth Control: FDA-approved contraceptive methods, sterilization procedures, and patient education, excluding abortifacient drugs
BRCA genetic testing counseling for higher-risk women
Breast Cancer Mammography screenings every 1 to 2 years for women over 40
Breast Cancer Chemoprevention counseling for higher-risk women
* Breastfeeding comprehensive support, counseling, and access to supplies for pregnant and nursing women
Cervical Cancer screening for sexually active women
Chlamydia Infection screening for younger women and higher-risk individuals
* Domestic and interpersonal violence screening and counseling
Folic Acid supplements for women planning pregnancy
* Gestational diabetes screening for women 24 to 28 weeks pregnant and those at high risk
Gonorrhea screening for higher-risk women
Hepatitis B screening for pregnant women during their first prenatal visit
* Human Immunodeficiency Virus (HIV) screening and counseling for sexually active women
* Human Papillomavirus (HPV) DNA Test: high-risk HPV DNA testing every three years for women 30+ with normal cytology results
Osteoporosis screening for women over 60 based on risk factors
Rh Incompatibility screening for all pregnant women and follow-up for higher-risk cases
Tobacco Use screening and interventions for all women, with additional counseling for pregnant users
* Sexually Transmitted Infections (STI) counseling for sexually active women
Syphilis screening for pregnant women and others at increased risk
* Well-woman visits to access recommended preventive services
For All Adults
Abdominal Aortic Aneurysm one-time screening for men within specific age ranges who have a history of smoking
Alcohol Misuse screening and counseling
Aspirin usage recommendations for men and women in certain age groups
Blood Pressure checks
Cholesterol screening for adults in specific age brackets or at elevated risk
Colorectal Cancer screening for individuals aged 50 and above
Depression screening
Type 2 Diabetes screening for adults with hypertension
Diet counseling for adults at increased risk of chronic illnesses
HIV screening for higher-risk adults
Immunization vaccines for adults—doses, recommended ages, and target populations vary:
Hepatitis A
Hepatitis B
Herpes Zoster (shingles—caused by the same virus as chicken pox, but the vaccine is for individuals aged 60 and older)
Human Papillomavirus
Influenza (Flu Shot)
Measles, Mumps, Rubella
Meningococcal
Pneumococcal
Tetanus, Diphtheria, Pertussis
Varicella (chicken pox)
Obesity screening and counseling
Sexually Transmitted Infection (STI) prevention counseling for higher-risk adults
Tobacco Use screening for all adults and cessation support for smokers
Syphilis screening for adults at increased risk
Now that you’re aware of the services available at no extra cost, go ahead and book that appointment you’ve been delaying.
Illustration by Angelica Alzona.
