Under the ACA, preventive care is 100% covered. Most people skip it anyway.
Sandra, 54, had a high-deductible health plan and had grown accustomed to avoiding the doctor unless something was clearly wrong. Doctor visits meant bills, and bills meant stress.
She had skipped her colonoscopy for three years running. Her primary care doctor had mentioned it at every annual visit. Sandra always said she'd schedule it soon. She never did.
Sandra's reasoning: with a $3,000 deductible, any procedure was going to cost something. She had once received a $400 bill after what she thought was a covered preventive visit. She didn't trust that "free" actually meant free.
What she didn't know: the ACA mandates that specific preventive services — including colonoscopies for adults over 50 — must be covered at zero cost to the patient. No deductible. No copay. By law.
The Affordable Care Act requires non-grandfathered insurance plans to cover a list of preventive services without cost-sharing. For women over 50, this includes mammograms, colonoscopies, blood pressure checks, cholesterol panels, diabetes screenings, and more.
The confusion arises because the visit must be coded correctly as preventive. If your doctor orders additional tests during a preventive visit, those add-ons can be billed separately. BillVeil's Preventive Care Checker shows exactly what's covered for your age and sex — and how to make sure it's billed correctly.
Sandra's colonoscopy cost her zero dollars. The pre-cancerous polyp her doctor removed would, if left untreated for another two to three years, likely have become colon cancer — the treatment for which averages $40,000–$150,000. She caught it because she finally learned the screening was free.