Preventive care explained: 29 things your health plan covers for free

Preventive care is one of the most powerful tools employees have to protect their health—but it’s also one of the most underused benefits in the U.S. While preventive services are designed to catch issues early, improve long-term health, and reduce avoidable costs, only 8% of adults receive all the preventive care the CDC recommends. As a result, many conditions that could have been detected early turn into chronic illnesses that are harder and more expensive to treat.

The stakes are high for both employees and employers. Chronic diseases driven by delayed care account for 75% of all healthcare spending, and employees who skip preventive visits are far more likely to experience costly emergency visits and complications later. For employers, that means higher premiums, unpredictable claims, and a growing financial burden across the organization. For employees, it can mean untreated symptoms, surprise bills, and care that feels confusing rather than supportive.

This guide breaks down what preventive care actually includes, what is covered at no cost under most health plans, and why helping employees use these benefits can meaningfully improve health outcomes, lower long-term costs, and strengthen your overall employee experience.

What is preventive care?

Preventive care refers to routine health services that help people stay healthy and catch issues early. These services include screenings, vaccines, counseling, and the annual wellness visit.

The goal of preventive health is simple: find conditions early, when they’re easier, safer, and less expensive to treat.

Why the preventive vs diagnostic difference matters

• Preventive services are typically free under Affordable Care Act–compliant plans when delivered by an in-network provider.
• Diagnostic services are not free, even if they occur during a preventive appointment.

A visit can switch from preventive to diagnostic if a provider evaluates symptoms or orders tests to investigate a concern. Clarity around this distinction reduces surprise bills and builds trust in the benefits program.

What is covered under preventive care?

Most plans cover the following preventive services at no cost when performed in-network. You can share this list directly with employees:

1. Annual preventive visits

Employees often search “wellness exam vs physical” or “annual wellness visit vs physical” because terms vary by provider. Here’s the clean distinction:

Annual wellness visit (preventive):

• Includes medical history review, lifestyle counseling, routine screenings, and basic vitals
• Free when billed as preventive

Physical exam (may include diagnostic care):

• Can involve symptom evaluation or diagnostic tests
• May include costs

Employee tip: When scheduling, ask the provider to book the appointment as a preventive annual wellness visit and confirm no diagnostic services will be added unless medically necessary.

2. Screenings

Most health plans cover the following screenings at no cost:

• Cancer screenings (mammograms, colonoscopies, cervical cancer tests)
• Blood pressure, cholesterol, and diabetes screenings
• Depression and substance use screenings
• STI and HIV screenings
• Pediatric developmental screenings

Early detection reduces the likelihood of costly emergency care or long-term complications.

3. Vaccinations

Vaccines are a core part of preventive care and are covered in-network:

• Flu shots
• COVID-19 vaccines
• Tdap
• Shingles
• Pneumococcal
• HPV
• Routine pediatric immunizations

4. Preventive medications & pregnancy-related care

Many plans also cover:

• Prenatal screenings
• Breastfeeding counseling and breast pumps
• Statins, aspirin therapy, PrEP, and other preventive medications
• Folic acid supplements

5. Pediatric preventive care

Children receive the same preventive protections, including:

• Well-child visits
• Routine vaccinations
• Growth and developmental screenings

Why preventive care matters for employees and employers

Preventive care isn’t just a personal health decision—it’s a foundational part of a healthy, financially sustainable workplace. When employees delay or skip routine screenings, checkups, and annual wellness visits, small issues can become costly conditions that affect both individual well-being and organizational budgets. For employers, low utilization of preventive services can drive higher claims, rising premiums, and increased absenteeism. For employees, it can mean avoidable health problems, surprise bills, and care that feels reactive instead of supportive.

Health impact

Preventive care supports long-term well-being by catching issues early. Routine preventive services improve chronic disease outcomes and reduce avoidable complications.

Financial impact

Because most preventive services are free in-network, employees avoid out-of-pocket costs. Employers benefit through fewer high-cost claims, ER visits, and hospitalizations.

Organizational culture impact

A strong preventive health strategy reinforces that employees are supported. It can reduce absenteeism, improve productivity, and strengthen retention.

How HR leaders can increase preventive care utilization

HR is often the first place employees turn when they’re unsure how to use their health benefits. That puts HR leaders on the front lines of preventive health, shaping whether employees understand their coverage, know what’s free, and feel confident scheduling the care they need.

When preventive care isn’t clearly communicated, employees delay routine services, miss early warning signs, and face higher out-of-pocket costs. But when HR provides clear, repeated, and accessible guidance, preventive care utilization rises and the entire workforce benefits.

If you’re an HR leader on a mission to promote preventive care, consider incorporating:

• Clear onboarding guidance about preventive care
• Simple explanations of preventive vs diagnostic
• Education on wellness exam vs physical distinctions
• Encouragement to select a primary care physician
• Reminders to use in-network providers
• Seasonal campaigns (e.g., flu shot reminders)
• Preventive care FAQs in your benefits hub

These steps reduce confusion and cut down the number of benefits questions directed to HR.

Giving employees the tools to easily understand what’s covered

Even when preventive care is free, many employees still struggle to understand what’s covered and what isn’t. Benefits information often lives across multiple carrier sites, PDFs, and plan documents, making it hard for people to get clear answers when they need them. That confusion can keep employees from scheduling preventive care or lead to surprise bills when a preventive visit becomes diagnostic.

This is where good tools matter. Technology can remove the guesswork and give employees fast, reliable guidance about their own coverage. With the Nava Benefits App, employees can use the built-in AI assistant to ask questions like “Is my annual wellness visit covered?” or “Is this lab test preventive or diagnostic under my plan?” The assistant reviews the employee’s specific health plan details and provides clear, personalized answers in seconds.

For HR teams, this means fewer repeated questions, less time digging through plan documents, and more confident, informed employees. For employees, it means understanding their benefits without the frustration so they can focus on getting the preventive care that keeps them healthy.

Frequently asked questions

Is preventive care really free?

Yes, when provided in-network and billed strictly as preventive. Diagnostic testing or symptom evaluation is not free.

Does preventive care include labs?

Routine labs such as cholesterol and glucose screenings are covered. Labs ordered to investigate a symptom are diagnostic.

What is the difference between an annual wellness visit and a physical?

The annual wellness visit is preventive and generally free. A physical may include diagnostic work that carries costs.

Do I need a primary care physician to access preventive care?

Not always, but having a PCP helps employees coordinate care, stay up-to-date on preventive health, and avoid unnecessary diagnostic charges.

Can preventive care become diagnostic during an appointment?

Yes. If a provider evaluates a symptom or orders tests due to a concern, the billing shifts to diagnostic.

How employees can confirm a visit is preventive

1. Ask the provider to schedule the appointment as a preventive annual wellness visit.
2. Confirm the provider is in-network.
3. At check-in, verify that the visit will be billed as preventive only.
4. Understand that discussing symptoms may shift the visit to diagnostic.

Key takeaways

• Preventive care includes screenings, vaccines, counseling, and the annual wellness visit.
• Most preventive services are free when provided in-network and billed as preventive.
• Understanding preventive vs diagnostic is essential for avoiding surprise bills.
• Employees benefit from clarity on wellness exam vs physical differences.
• HR can significantly increase preventive care utilization through simple education and reminders.