You have questions about preventive care coverage — Ohio Health Benefits has answers.
If you’re enrolled in an ACA-compliant health plan in Ohio, you’re entitled to a broad range of preventive care services at zero out-of-pocket cost. No copay. No deductible. No bill. Yet millions of Ohioans skip these free services every year — often because they simply don’t know what’s included.
As a locally-owned independent insurance broker serving all of Ohio from our offices in Tallmadge, Hiram, and Canton, Ohio Health Benefits helps individuals, families, and businesses make sense of their coverage. This guide breaks down exactly what preventive care benefits most Ohio health plans are required to cover — and how to put those benefits to work for you.
What Is Preventive Care, and Why Is It Fully Covered?
Preventive care refers to routine health services designed to detect, prevent, or manage conditions before they become serious — things like annual physicals, vaccines, cancer screenings, and wellness counseling.
Under the Affordable Care Act (ACA), most private health insurance plans must cover a defined set of preventive services without any cost-sharing. That means no copayments, no deductibles, and no co-insurance when you receive these services from an in-network provider.
In June 2025, the U.S. Supreme Court upheld the ACA’s preventive care mandate, confirming these requirements remain fully in effect. So if your plan is ACA-compliant, your preventive benefits are protected.
This coverage applies to:
- ACA Marketplace plans (Bronze, Silver, Gold, and Platinum)
- Employer-sponsored group health plans (non-grandfathered)
- Ohio Medicaid expansion plans
One important note: Preventive services are covered at $0 only when seen by an in-network provider. If your doctor treats a separate condition during the same visit, that portion may be billed separately and subject to your regular cost-sharing.
Frequently Asked Questions About Preventive Care in Ohio
What preventive services are covered at no cost on Ohio health plans?
Covered preventive services fall into four broad categories, based on recommendations from the U.S. Preventive Services Task Force (USPSTF), the Advisory Committee on Immunization Practices (ACIP), and the Health Resources and Services Administration (HRSA).
Most ACA-compliant plans cover the following adult screenings at no cost:
- Annual wellness visit — Your once-a-year checkup with your primary care provider
- Blood pressure screening
- Cholesterol and lipid panel — For adults at elevated risk
- Type 2 diabetes screening — Adults ages 35–70 who are overweight or obese
- Depression screening
- Obesity screening and counseling
- Alcohol misuse counseling
- Tobacco use counseling and cessation support
- HIV screening — For adults ages 15–65
- STI screening and counseling — For those at increased risk
- Lung cancer screening (low-dose CT scan) — Adults ages 50–80 with a significant smoking history
- Abdominal aortic aneurysm (AAA) ultrasound — One-time screening for men ages 65–75 who have smoked
- Pre-exposure prophylaxis (PrEP) — HIV prevention medication for high-risk individuals
Ohio health plans that are ACA-compliant must cover these cancer screenings with no out-of-pocket cost:
- Colorectal cancer screening (colonoscopy or approved alternatives) — Starting at age 45
- Breast cancer screening (mammogram) — For women ages 40 and older
- Cervical cancer screening (Pap smear and/or HPV test)
- Lung cancer screening — For eligible adults ages 50–80
- Skin cancer counseling — For fair-skinned individuals ages 6 months to 24 years
All immunizations recommended by ACIP and listed on the CDC immunization schedules are covered at $0. This includes:
For children: Diphtheria, tetanus, and pertussis (DTaP) · Measles, mumps, and rubella (MMR) · Varicella · Hepatitis A and B · HPV · Influenza · COVID-19
For adults: Influenza (annual) · Shingles (Shingrix) · COVID-19 (updated boosters) · RSV · Mpox · Tdap/Td booster · Pneumococcal · Hepatitis A and B
Women enrolled in ACA-compliant Ohio health plans receive additional preventive services at no cost under HRSA’s Women’s Preventive Services Initiative:
- Well-woman visits (annual)
- All FDA-approved contraceptive methods — Including pills, IUDs, implants, and emergency contraception
- Gestational diabetes screening (during pregnancy)
- Breastfeeding support and counseling
- Intimate partner violence screening and counseling
- Osteoporosis screening — Women age 65+ (or younger if at elevated risk)
- BRCA risk counseling — For women with a family history of breast or ovarian cancer
- Anemia screening — During pregnancy
- Folic acid supplementation — For women who may become pregnant
Under HRSA’s Bright Futures guidelines, covered services for Ohio children include:
- Well-child visits and developmental screenings (by age)
- Vision and hearing screenings
- Height, weight, and BMI tracking
- Lead and anemia screenings
- Autism spectrum disorder screening
- Depression and behavioral health screenings for adolescents
- STI screening for sexually active teens
- All recommended childhood vaccines
- Oral health risk assessment and fluoride supplementation
Not sure which category your plan falls into? That’s exactly the kind of question Ohio Health Benefits is here to answer. Our agents work with individuals, families, and businesses across Ohio to review your plan, explain your benefits, and make sure you’re getting the most out of your coverage — at no charge to you.
Why Skipping Preventive Care Costs You More in the Long Run
Many Ohioans avoid scheduling screenings or annual visits thinking they’re saving time or money. The reality is the opposite. Conditions caught early — whether it’s high blood pressure, early-stage cancer, or prediabetes — are dramatically less expensive and easier to treat than those discovered after they’ve progressed.
Your health plan has already paid for these services. All you have to do is use them.
How to Make the Most of Your Free Preventive Benefits
- Confirm your plan is ACA-compliant — Most Marketplace and employer plans qualify
- Stay in-network — Out-of-network providers may result in a bill
- Schedule your annual wellness visit — This is distinct from sick visits and fully covered
- Know your screenings by age and risk — Ask your doctor which ones apply to you
- Review the full list at HealthCare.gov — healthcare.gov/preventive-care-benefits
- Call Ohio Health Benefits if you have questions — We’re here to help at no cost to you
Ohio Health Benefits: Your Local Guide to Health Insurance
Choosing the right health plan — and understanding what it actually covers — shouldn’t feel overwhelming. Ohio Health Benefits is a locally-owned, independent insurance broker with offices in Tallmadge, Hiram, and Canton, serving clients across all of Ohio.
Our agents don’t charge for their services. We represent all major carriers, which means we find the plan that fits your needs and budget — not the plan that benefits us. Whether you’re looking for individual coverage, a family plan, or a group benefits package for your employees, we offer:
- Group Health (Fully Insured and Self-Funded)
- HRA/HSA Third Party Administration
- Dental, Vision, and Life Insurance
- Short- and Long-Term Disability
- Telemedicine and ancillary benefits
We have a reputation for personal attention, flexibility, dependability, and integrity — and we’ll be here to support you throughout the year, not just at enrollment.
Have questions? Call us:
Individual & Family Coverage: 330-633-7713
Group Benefits: 330-633-3837
