Understanding Wellness Coverage under the ACA: 100% Covered and Why It Matters

By: Michael Kopek February 27, 2025 1:23 am

Time to read: 5 Minutes

At Healthy Wealthy Health, we’re here to help you make the most of your health insurance—and it starts with keeping you healthy. One of the biggest perks of the Affordable Care Act (ACA)? 

It covers a wide range of preventive and wellness services at 100%, meaning no copays, no deductibles, no out-of-pocket costs—as long as you stick with an in-network provider.

Whether you’re browsing plans through us or just want to understand your options, let’s break down what’s covered, why it matters, and how it can keep you healthier without hitting your wallet.

What Does “100% Covered” Really Mean?

Under the ACA, most private health insurance plans—whether from the Health Insurance Marketplace or through many employer-sponsored options—are required to fully cover certain preventive services. That means no copays, coinsurance, or deductibles when you visit an in-network provider.

It’s simple:

• You go for an annual checkup or screening? You pay $0.
• Need a flu shot or a mammogram? Covered.
• Want counseling to quit smoking? That’s free too.

The key? Stay in-network. Out-of-network services might not get the same coverage, so check your plan’s provider list before booking.

Heads up: Some “grandfathered” plans (older plans that predate the ACA and haven’t changed much) may not offer these benefits. It’s worth double-checking.

What Wellness Services Are Included?

The ACA’s preventive care list is designed to catch health issues early—or stop them before they start. Here’s what’s included at no cost to you:

• Annual Checkups: Your yearly wellness visit is covered, giving you a chance to review your health, get advice, and catch issues early.
• Screenings: Depending on age, gender, and risk factors, you could get covered tests like mammograms, colonoscopies, cholesterol checks, blood pressure tests, and diabetes screenings.
• Vaccinations: From flu shots to MMR (measles, mumps, rubella) for kids and HPV for teens and young adults—it’s all covered.
• Counseling Services: Need help with smoking cessation, weight management, or mental health? Counseling for these is included too.
• Women’s Health: Well-woman visits, birth control (pills, IUDs, etc.), breastfeeding support, and cervical cancer screenings are fully covered.
• Pediatric Care: Kids get wellness visits, developmental screenings, and all their necessary vaccines to keep them healthy.

These services aren’t chosen at random. They’re backed by leading health organizations like:

• U.S. Preventive Services Task Force (USPSTF)
• Advisory Committee on Immunization Practices (ACIP)
• Health Resources and Services Administration (HRSA)

The ACA relies on their expertise to decide which services make the list.

Why This Is a Game-Changer for Your Health

Here’s the deal: Money is the number one reason many people skip going to the doctor—even for preventive care. Copays and deductibles can make a simple checkup feel like a luxury.

The ACA eliminates that barrier for preventive services. When cost isn’t an issue, you’re more likely to:

• Get regular screenings that catch diseases early (when they’re easiest to treat).
• Stay up-to-date on vaccines that protect you and your family.
• Seek counseling for things like quitting smoking or managing stress.

Think about it:

• A $50 copay might have stopped you from getting a mammogram—but now it’s free, and it could save your life.
• That flu shot you skipped last year? No more excuses—it’s covered.
• Want help quitting smoking? Covered counseling can make it easier to succeed.

Studies show that when preventive care is free, more people use it—and that means fewer serious illnesses and lower healthcare costs down the road.

Healthy Wealthy Health Has Your Back

We’re here to make sure you’re not missing out on these perks. Whether you’re shopping for a Marketplace plan or reviewing your employer’s coverage, our team will walk you through what’s 100% covered and help you pick a plan that works best for you.

Need help understanding your coverage? Curious about plan options?
We’ve got you.

Reach out today, and we’ll make sure you’re getting the most from your health insurance—because staying healthy shouldn’t come with a price tag.

Beyond Individuals: Workplace Wellness & Public Health

The ACA didn’t just focus on individual coverage—it’s also changing how businesses and communities approach health.

• For Employers: Companies with 50+ full-time employees often offer health plans with preventive benefits. Many are also incentivized to provide workplace wellness programs (like gym memberships or smoking cessation help) with rewards that can lower premiums by up to 30%—and even 50% for tobacco-related programs.
• Public Health Funding: The Prevention and Public Health Fund (part of the ACA) supports community health initiatives—like free health screenings, nutrition education, and vaccination drives—making wellness more accessible for everyone.

It’s all about shifting from treating illness to promoting health on a larger scale.

A Few Things to Watch Out For

While the ACA’s preventive coverage is a major win, there are a few caveats:

• Grandfathered Plans: Some older plans may not include full preventive coverage.
• Follow-Up Tests May Cost You: Preventive screenings are free, but if something abnormal is found, follow-up tests or treatments might come with a bill.
• Short-Term Plans: Many short-term health plans don’t follow ACA rules, so preventive services may not be covered.

Tip: Always check with your insurer—or ask us—to make sure you’re in the clear before booking services.

The Bottom Line — Stay Healthy for Free

The ACA’s 100% preventive coverage means staying on top of your health without worrying about the cost. From flu shots to cholesterol checks, well-baby visits to cancer screenings, it’s all yours—no copays, no deductibles, no stress.

At Healthy Wealthy Health, we’ll help you find a plan that puts your health first—without breaking the bank.

Ready to take advantage of your coverage?
Contact us today.

Because your health is worth it, and we’ll make sure your insurance proves it.

FAQs:

Q1: What preventive services are covered under the ACA?

A: Services include annual checkups, screenings (mammograms, colonoscopies), vaccinations, counseling, women’s health services, and pediatric wellness visits—all fully covered when using in-network providers.

Q2: Do I have to pay anything for preventive services?

A: No. Preventive services are covered at 100% when done in-network. However, follow-up tests after screening may have associated costs.

Q3: Are short-term health plans required to cover preventive services?

A: No. Short-term plans typically do not follow ACA guidelines and may not include preventive coverage.

Q4: What are the ten essential health benefits mandated by the Affordable Care Act?

The ACA requires coverage of ten essential health benefits. These include outpatient care, emergency services, hospitalization, maternity and newborn care, mental health and substance use services, prescription drugs, rehabilitative services, laboratory services, preventive and wellness services, and pediatric services.