Important Update: No-Cost Preventive Services Coverage

What This Means for You and Your Family

Hi everyone! I’m Rikki Topps with Topps Insurance – your caring Florida insurance agent. I love helping families and individuals find the right health coverage, whether it’s individual Marketplace plans, off-Exchange options, or group/employee benefits through worksite solutions. One of the best parts of ACA-compliant plans? Many preventive services are covered at $0 cost to you—no copays, coinsurance, or deductibles—even if you haven’t met your deductible yet!

You might have seen (or will soon see) updates from carriers or the Marketplace around September 2025 reminding us about this key benefit. It’s a great time to refresh on what it covers and why it’s such a win for staying healthy. (Insurance, made easy and caring – that’s the Rikki way!)

What Are These No-Cost Preventive Services?

Under the Affordable Care Act (ACA), most non-grandfathered health plans must cover certain preventive care without charging you anything out-of-pocket. These come from trusted experts like the U.S. Preventive Services Task Force (USPSTF), Advisory Committee on Immunization Practices (ACIP), and Health Resources and Services Administration (HRSA). This is one of the most loved ACA features because it helps catch health issues early—saving money and lives!

Why This Matters in 2025 (and Beyond)

There were some court challenges (like the Braidwood Management case), but in June 2025, the Supreme Court upheld the core requirement: No-cost coverage for USPSTF-recommended preventive services stays in place for the vast majority of plans. No big changes or losses here—it’s still fully protected! These reminders from carriers help us all stay on top of compliance and give you peace of mind when talking about your coverage.

Clients often tell me: “I had no idea my annual check-up or vaccines were free!” It’s a huge perk I love sharing.

Common No-Cost Preventive Services (Always Check Your Plan for Details)

Here’s a quick list of what’s typically covered at $0 when done in-network:

For Adults (Men and Women):

Annual wellness visits / preventive check-ups
Blood pressure and cholesterol screenings
Colorectal cancer screening (often starting at age 45–50)
Type 2 diabetes screening
Depression screening
Tobacco cessation counseling and support
Vaccines (flu, COVID-19, shingles, and more per ACIP)
HIV screening and counseling
Hepatitis screenings

Extra for Women:

Well-woman visits
Breast cancer screenings (mammograms)
Cervical cancer screenings (Pap tests/HPV)
Contraception counseling and FDA-approved methods (as prescribed)
Gestational diabetes screening
Folic acid supplements

For Children:

Well-child visits (birth to age 18)
Immunizations (per CDC schedule)
Behavioral and developmental assessments
Vision and hearing screenings
Autism screening

Other Great Additions in Recent Years:

HIV PrEP (pre-exposure prophylaxis) at no cost
Breastfeeding support and equipment
Certain screenings for pregnant individuals

Important note: Stick to in-network providers for true $0 cost—out-of-network might have charges.

How I Help You Make the Most of This Benefit

As your agent, here’s what I always do for clients:

Highlight it upfront — When we review plans (individual or group/worksite benefits), I point out: “One awesome thing about ACA coverage is free preventive services—like your yearly physical, cancer screenings, and shots—to keep you and your family healthy without extra bills.”
Check the specifics — I review your Summary of Benefits and Coverage (SBC) or preventive care list to confirm exactly what’s covered for your plan.
Answer common questions — Like:
- “Why was my screening free but the follow-up test cost money?” → Preventive is $0; if something’s found and it becomes diagnostic, cost-sharing may apply.
- “Does this cover my employer/group plan?” → Yes, for most non-grandfathered plans (which is the majority!).
- “What if a service isn’t covered?” → Let’s verify it’s on the official lists and in-network.
Stay compliant and honest — I focus on facts: These preventive perks encourage early detection and better health—no misleading “everything’s free” claims.
Keep an eye on updates — Recommendations can evolve (like age ranges for screenings), so I check Healthcare.gov, CMS, and carrier portals regularly.

Quick conversation starters I use:

“Great news—your plan covers preventive care at no extra cost to help you stay ahead of health issues.”
“Annual check-ups, flu shots, or mammograms? Usually $0 in-network—it’s one reason ACA plans are so valuable.”

This benefit is a real game-changer—it saves you money while promoting wellness for you and your loved ones.

If you have questions about no-cost preventive services, your Marketplace plan, group benefits, or how recent updates affect your coverage, I’m here to help simplify it all. Give me a call at 813-517-7953, email RikkiToppsInsurance@gmail.com, or fill out the Talk With An Agent form on my site. You’re family to me, and I’ve got your back!

Don’t Let Insurance Get Tricky, Call Rikki!

Still have questions?

Feel free to contact me at RikkiToppsInsurance@gmail.com or by phone at 813.517.7953, and I’ll be happy to answer any other questions you have. (License #W282762)

(Info aligned with current ACA guidelines from Healthcare.gov/preventive-care-benefits and recent Supreme Court affirmation in Kennedy v. Braidwood Management.)