Your last annual physical came and went. The doctor checked your blood pressure, maybe ordered a cholesterol panel, and sent you on your way. Nobody mentioned the free colonoscopy you may have been eligible for, or the smoking cessation prescriptions, or the 16-session diabetes prevention program sitting unused in your benefits package. These are not specialty services that require a lengthy fight with your insurer. They are standard covered benefits, and most of them cost you nothing.
Most non-grandfathered private health plans, including employer plans and ACA marketplace plans, are required by federal law to cover a long list of preventive services at zero cost-sharing when you use an in-network provider. That means no copay, no coinsurance, and it counts before you hit your deductible. The catch is that nobody sends you a reminder. A few items on this list are specific to Medicare, and those are noted. The rest apply broadly to most private plans.
Your insurer's member portal has a full preventive care benefit list. It's worth pulling up before your next appointment.
Colon cancer screening now starts at 45, not 50
Many people still operate on the old rule: get a colonoscopy when you turn 50. The screening age changed in 2021, when the U.S. Preventive Services Task Force lowered it to 45 for adults at average risk. Under the ACA, that update came with a coverage mandate: most plans must now cover colorectal cancer screening starting at age 45 at no out-of-pocket cost.
Screening options include a colonoscopy every 10 years, a stool-based DNA test every one to three years, or an annual stool blood test, depending on the method. Coverage applies to the screening itself. If a colonoscopy is being done because you have symptoms, or to follow up on a polyp found during a previous screening, it shifts from preventive to diagnostic and your normal cost-sharing may apply. Ask your provider explicitly how the visit will be coded before you go in.
Colon cancer rates in adults under 50 have risen sharply over the past two decades. The age change was a direct response to that trend. A large share of people now eligible for a free, potentially life-saving screening have no idea they qualify.
A free low-dose CT scan if you've smoked heavily
If you're between 50 and 80, smoked heavily for a prolonged period, and either still smoke or quit within the last 15 years, annual low-dose CT lung cancer screening is covered at no cost under most private plans and Medicare. The eligibility threshold is roughly a pack a day for 20 years, or the equivalent. The scan looks for early-stage lung cancer when treatment options are far better than at later stages.
This is a quick, non-invasive test. No contrast dye, no prep, no hospital stay. It takes about 10 minutes. Most people who qualify have never been offered it. Your primary care provider can write the referral, and coverage kicks in from there.
Lung cancer is the leading cause of cancer death in the United States. Catching it early, before symptoms appear, is the scenario where screening saves lives. If you or someone in your household spent years as a heavy smoker, this is worth asking about at the next physical.
Hepatitis C testing for nearly every adult
Hepatitis C screening is covered at no cost for all adults aged 18 to 79 under most non-grandfathered private plans. Hepatitis C infection can sit in the liver for 20 or 30 years without producing symptoms most people would recognize. Many people who contracted it through blood transfusions before universal blood supply screening began in 1992, or through shared drug equipment, have never been tested and don't know they're infected.
The test is a simple blood draw, typically ordered as part of a routine physical. If the screening comes back positive, follow-up testing is covered as well. And treatment options today are vastly better than they were a decade ago. Hepatitis C is now curable in most cases with an 8- to 12-week course of oral medication.
The screening recommendation covers nearly the entire adult population, not just people who know they might be at risk. The point is to find infections that would otherwise go undetected for years. This is one of the most consistently underused free preventive benefits in existence.
A free ultrasound for aortic aneurysm if you smoked and are older
This one is specific to Medicare. Men between 65 and 75 who have smoked at least 100 cigarettes in their lifetime qualify for a one-time free abdominal aortic aneurysm screening ultrasound. People with a family history of the condition are also eligible. The test is non-invasive and covered at $0 when done by a provider who accepts Medicare assignment.
An abdominal aortic aneurysm is a bulge in the large artery that runs through the abdomen. It produces no symptoms until it ruptures, at which point the outcome is often fatal. The ultrasound takes about 30 minutes and can catch an aneurysm early, when it can be monitored or surgically repaired before a rupture occurs.
Medicare offers this as a one-time benefit. You can access it through the “Welcome to Medicare” preventive visit or with a referral from your regular doctor. If you're in the eligible age range and smoked at any point in your life, there is no reason not to schedule this. One appointment, no cost, potentially life-saving information.
Smoking cessation medications, not just a hotline number
The free state quitlines are well-publicized. Less known is that most plans are also required to cover tobacco cessation medications, including prescription options like varenicline (brand name Chantix) and bupropion, as well as over-the-counter nicotine replacement products like patches, gum, and lozenges when prescribed by a provider. The ACA's tobacco cessation benefit covers both counseling sessions and FDA-approved medications, without cost-sharing.
Coverage details vary by plan. Some cover all forms of nicotine replacement therapy without a prescription visit. Others require a provider visit first. But the mandate is clear: this is a covered benefit, not a discount program. The combination of medication and counseling is significantly more effective than quitting cold turkey, and medications in particular are the piece people most often skip because they don't know their plan will cover them.
If you've tried to quit and struggled, ask your doctor specifically about prescription cessation medications. Many people pay out of pocket for nicotine patches or never try the prescription options because they assume insurance won't cover them. In most cases, it will.
Intensive behavioral counseling for obesity
Your annual physical includes a BMI check. What goes unclaimed is the counseling that's supposed to follow it. Under the ACA, obesity screening and counseling is a no-cost preventive service for adults. Under Medicare, that extends to intensive behavioral therapy, a structured series of individual face-to-face sessions at a primary care setting. Covered sessions are available every week for the first month, every other week for months two through six, and monthly after that if you're making progress.
The counseling focuses on diet, physical activity, and behavioral strategies for weight management. It is not a two-minute conversation about eating less and moving more. It is a clinical program, and it is delivered in primary care settings, not at a gym or a commercial weight loss program you'd pay for yourself.
Most people with obesity have never been told this coverage exists. If you ask specifically about intensive behavioral therapy for obesity, or IBT, rather than asking for a general weight loss referral, you're asking for a specific covered service. The visits are there; the challenge is getting the provider to treat them as such.
The National Diabetes Prevention Program
If a doctor has told you your blood sugar is in the prediabetes range, there is a structured, CDC-approved lifestyle program designed to prevent you from developing Type 2 diabetes, and it is a covered benefit under Medicare. The Medicare Diabetes Prevention Program covers up to 16 core group sessions of intensive lifestyle counseling, followed by ongoing maintenance sessions, at no cost to Medicare beneficiaries.
The program addresses eating habits, physical activity, and stress management. The evidence base is solid: participants who complete it reduce their risk of progressing to Type 2 diabetes substantially. As of 2026, CMS has added asynchronous online delivery options, which means you can complete sessions digitally without scheduling live group meetings.
Many commercial plans also cover the National DPP, and participation has expanded significantly over recent years. If your A1C came back between 5.7 and 6.4, or your fasting glucose was elevated, ask your plan whether the program is covered before you spend money on something comparable out of pocket. The blood sugar tests that establish eligibility are also covered as free preventive services.
A free breast pump and lactation support
Under the ACA's women's preventive health guidelines, most plans are required to cover breastfeeding supplies, including breast pumps, and breastfeeding counseling from a lactation consultant at no cost. The coverage applies before and after delivery. New and expecting parents miss this benefit constantly, either because nobody tells them, or because they buy a pump through the wrong channel and end up paying for it.
What's actually covered varies by plan. Some plans cover only a basic electric pump. Others cover a hospital-grade double electric pump through a participating durable medical equipment supplier. The key is calling your insurer before you buy anything, ideally in the second trimester, to find out which pumps are covered and which approved suppliers you have to use. Going off the approved list or ordering directly from Amazon typically means you're paying yourself.
The lactation consultant benefit is the more underused piece. A certified lactation consultant can bill your insurance for postpartum support visits. Those sessions often run $150 or more at a private practice and cost nothing when billed as a covered preventive service. This applies to multiple visits, not just one. If breastfeeding is difficult in the early weeks, you don't need to navigate it alone on your own dime.
Generic statins at no cost
If you're between 40 and 75, haven't had a heart attack or stroke, and have at least one cardiovascular risk factor (high blood pressure, high cholesterol, diabetes, or a history of smoking), you may be eligible for statin preventive medication at no cost-sharing under your ACA-compliant plan. The USPSTF gave low-to-moderate dose statins a B-grade recommendation for this population, which under the ACA triggers the zero-cost coverage requirement.
Statins like atorvastatin and lovastatin are available as generics, and some plans have been covering them at $0 for eligible patients for years. Many people on statins pay $20 to $40 a month or more at the pharmacy and have no idea their plan is supposed to cover the medication as a preventive service. Others have risk factors but were never told a statin might be appropriate, let alone free.
This requires a 10-year cardiovascular risk assessment from your doctor to qualify. It is not automatic. But if you have the risk factors and you're in the age range, it is worth having the conversation at your next physical and asking specifically whether you qualify for zero-cost preventive statin coverage under your plan.
Alcohol misuse counseling
Few people mention how much they drink at an annual physical. And that largely explains why this benefit almost never gets used. Alcohol misuse screening and up to four brief face-to-face counseling sessions are covered at no cost under most ACA-compliant plans. The benefit is specifically for people who drink too much but are not alcohol-dependent. That distinction matters.
This is not addiction treatment. It is a brief intervention for people in the gray zone. If you drink more than seven drinks per week (for women) or 14 per week (for men), or regularly drink more than three to four drinks on any single occasion, you likely qualify. The screening is a few standard questions. If you screen positive, the counseling sessions follow, also at no cost, in a primary care setting.
The screening requires you to be honest with your doctor about your intake, which is the real barrier. The questions are brief and non-judgmental, and the counseling sessions are not a referral to an addiction program. They are short, structured conversations meant to help people cut back. Most people who would qualify have never accessed this simply because the conversation never started.
STI testing and counseling
HIV screening for adults aged 15 to 65, syphilis screening for people at higher risk, and behavioral counseling for sexually active adults at increased risk of sexually transmitted infections are all covered as no-cost preventive services under most private plans. So is gonorrhea and chlamydia screening. These tests are often paid for out of pocket, or skipped entirely, because most people don't know they're already included in their plan's preventive benefits.
The coding matters here. If you walk in requesting STI tests, rather than having them included as part of a scheduled preventive care visit, the lab work can be billed as diagnostic rather than preventive, which changes what you pay. To avoid that, schedule a preventive care appointment specifically and ask your provider to include STI screening as part of the visit.
The counseling benefit is even less visible. Two face-to-face high-intensity counseling sessions per year are available for sexually active adults at increased risk of infection, at no charge, in a primary care setting. These are brief behavioral health conversations focused on reducing risk. If STI testing has previously come out of your own pocket, it doesn't have to.
Acupuncture for chronic low back pain
This benefit is specific to Medicare, but it's worth knowing about because most people who qualify are paying out of pocket or not getting treatment at all. Medicare covers up to 12 acupuncture sessions within 90 days for chronic low back pain, with up to 8 additional sessions if you're showing improvement, for a maximum of 20 sessions per year. After meeting your Part B deductible, you pay 20% of the Medicare-approved amount, not the $75 to $150 cash price typically charged per session.
The pain must be nonspecific (meaning not caused by cancer, infection, or inflammation) and must have persisted for at least 12 weeks. You do not need to request a formal referral, but the acupuncture must be performed by a provider who has the appropriate credentials and accepts Medicare. Licensed acupuncturists cannot bill Medicare directly; the treatment must be delivered by a qualified physician or mid-level provider with acupuncture training.
Many commercial plans also cover acupuncture, particularly for musculoskeletal conditions, though coverage varies widely by insurer. If you've been managing chronic back pain, it's worth calling your plan to ask what's covered before continuing to pay cash for sessions.
Depression screening
This is a brief preventive check, entirely separate from mental health treatment. Depression screening is a required no-cost preventive service for all adults under most private plans. A provider screens you with a standard questionnaire during a regular visit. The screening costs you nothing and takes under five minutes.
The distinction from ongoing mental health care matters. The screening itself, a set of questions your primary care doctor is supposed to ask at a preventive visit, is free under the ACA's preventive care mandate. Ongoing therapy, psychiatric care, or treatment for a diagnosed condition is covered under your mental health benefits, subject to normal cost-sharing. The screening is the step that might prompt the referral, and it should not cost you anything.
Most people who have depression symptoms don't bring them up at their annual physical. The screen doesn't require you to raise the subject. It's a set of standardized questions your provider should be asking. If yours doesn't include it, you can request it. Asking specifically for a depression screening as part of your preventive visit is a reasonable thing to say out loud.
Domestic violence screening and counseling
Under the ACA's women's preventive health guidelines, screening and brief counseling for interpersonal and domestic violence is a covered service at no cost for women of reproductive age. The screening can be done during a routine preventive care visit with a primary care physician, OB-GYN, or other provider, billed as preventive care, with no out-of-pocket cost.
In practice, this benefit is almost entirely unclaimed, and the reason is simple: providers often don't ask, and patients don't bring it up. The benefit exists because healthcare visits are one of the few settings where someone in a dangerous home situation might be asked, in private, whether they're safe. A brief, direct screening question from a provider can be the first opening in a situation that otherwise has no obvious exit.
The counseling piece that follows a positive screen includes referrals and support resources. It is private, covered, and available at any preventive care appointment. If you are in a situation where this applies, or if you know someone who might be, a preventive care appointment is a reasonable and covered setting to start that conversation.
Check your plan's member portal or call the number on the back of your insurance card before your next appointment. Ask specifically which preventive services are covered at zero cost-sharing with in-network providers. Most of what's on this list is already in your benefits package. The challenge has never been the coverage. It's knowing to ask for it.
