Last updated: January 2025
"Don't worry, preventive care is 100% free with all ACA plans!"
That's what the insurance agent said. That's what the website said. That's what everyone said.
What they didn't say: Their definition of "preventive" is so narrow that a papercut wouldn't qualify.
Last month's "preventive" care visit bill: $1,847.
What They Claim Is Free
According to healthcare.gov, these preventive services are covered 100%:
- Annual wellness visit
- Basic immunizations
- "Certain" screenings
- "Some" preventive medications
Sounds great! Except...
What Actually Happened at My "Free" Preventive Visit
My Annual Wellness Visit Breakdown:
Free parts:
- Blood pressure check: $0
- Weight check: $0
- Basic blood panel: $0
- Depression screening questionnaire: $0
Surprise charges:
- "I've been having headaches": $295 (problem-focused visit)
- "My knee hurts when I run": $340 (additional complaint)
- Vitamin D test: $127 (not considered preventive)
- Thyroid panel: $289 (not basic screening)
- EKG (I'm 45): $380 (not preventive until 50)
- Extended discussion about diet: $200 (counseling beyond scope)
- Skin check for moles: $216 (dermatology referral needed)
Total "free" preventive visit: $1,847
The Exact Words That Cost You Money
Say these during your "free" visit and watch charges appear:
"I've been feeling..." - Boom, problem-focused visit, $295
"Can you check this?" - Diagnostic exam, $200+
"Should I be worried about...?" - Medical consultation, $340
"My family has a history of..." - Risk assessment, $275
"Last month I noticed..." - Symptom evaluation, $380
The second you mention ANYTHING wrong, it's no longer preventive.
The Colonoscopy Scam
Colonoscopy screening is "free" at 45. Here's what they don't tell you:
The "Free" Colonoscopy:
- Screening colonoscopy: $0
The Actual Bill:
- Anesthesia: $1,100 (not included in "free")
- Facility fee: $800 (separate from procedure)
- Polyp removal: $1,400 (now it's "treatment" not screening)
- Pathology: $580 (testing the polyp)
- Recovery room: $340
Total "free" colonoscopy: $4,220
If they find ANYTHING, even a benign polyp, it instantly converts from preventive screening to medical treatment. Full price.
The Mammogram Trap
"Free" screening mammogram:
- Basic mammogram: $0
What actually happens:
- "Dense breast tissue, need additional views": $340
- Ultrasound follow-up: $450
- Suspicious area found: $890 (diagnostic now)
- Biopsy recommended: $2,400
- It's benign but now you need monitoring: $600 every 6 months
Total for "free" mammogram cascade: $4,680
The Blood Work Bait and Switch
What's actually free:
- Basic metabolic panel
- Complete blood count
- Cholesterol (once per year)
What you probably need but isn't free:
- Vitamin D: $127
- B12: $98
- Thyroid (TSH): $145
- A1C (if not diabetic): $89
- Hormone levels: $340
- Inflammation markers: $215
Doctor orders the "full panel." You think it's covered. Bill arrives: $1,014.
The Vaccination Lies
Actually free vaccines:
- Flu shot
- COVID vaccine
- Childhood vaccines (if you're a child)
Vaccines that should be free but aren't:
- Shingles vaccine (before 50): $450
- Travel vaccines: $200-800 each
- Hepatitis B (adults): $340
- HPV (over 26): $750
"Preventive care includes vaccinations!" *Terms and conditions apply
The Prescription Prevention Scam
Free preventive medications:
- Aspirin (for some)
- Folic acid (if pregnant)
- Few others
Preventive meds that aren't free:
- Statins (prevent heart disease): $180/month
- Blood pressure meds (prevent stroke): $140/month
- Diabetes prevention meds: $340/month
- Osteoporosis prevention: $280/month
They're literally called PREVENTIVE medications. Still full price.
Real Examples of "Preventive" Care Bills
Sarah's Story: "Went for free annual exam. Mentioned irregular periods. Doctor did exam. Bill: $1,240. They coded it as 'diagnostic' because I had a symptom."
Mike's Story: "Free prostate screening. PSA slightly elevated. Needed follow-up ultrasound and biopsy. Total: $3,800. Original screening was free though!"
Jennifer's Story: "Free skin cancer screening. Found suspicious mole. Biopsy: $580. Removal: $1,200. Follow-ups: $400 each. The free screening cost me $3,000."
What Other Countries Consider Preventive
Canada: Everything that prevents worse problems. Period.
UK: If it stops future illness, it's covered.
Japan: Prevention is healthcare. No distinction.
USA: Only these 47 specific services under these 193 specific conditions on alternating Tuesdays if you haven't eaten gluten.
The Direct Primary Care Difference
This is where MyPhysicianPlan makes sense.
With MyPhysicianPlan:
- Annual visits include whatever you need to discuss
- No surprise billing for asking questions
- Actual preventive care, not insurance-defined prevention
- One flat rate whether you mention symptoms or not
Traditional insurance punishes you for being thorough about your health. MyPhysicianPlan encourages it.
How to Game the "Free" Visit System
The Two-Visit Strategy:
The Magic Words:
- Say: "I'm here for my annual preventive care visit"
- Don't say: Anything about how you actually feel
The Pre-Visit Call:
"If I mention X during my preventive visit, will I be charged?" Get it in writing.The Billing Review:
Always appeal preventive care bills. Sometimes they code it wrong "accidentally."The Psychological Damage
We're trained to NOT mention health concerns during health visits.
Think about that.
We go to the doctor but stay silent about symptoms to avoid charges.
That's not preventive care. That's preventive silence.
The Real Cost of "Free" Preventive Care
My 2024 "free" preventive care:
- Annual physical that became diagnostic: $1,847
- "Free" colonoscopy with polyp: $4,220
- "Free" flu shot with travel vaccine question: $450
- "Free" mammogram for wife: $2,100
- "Free" kids' checkups with concerns: $890
Total for "free" preventive care: $9,507
The Bottom Line
"Free preventive care" is like "free shipping" that requires a $10,000 minimum order.
It exists, technically. But the moment you actually need healthcare - the moment you mention a symptom, find a polyp, need a vitamin level, or ask a question - it stops being free.
The insurance company's definition of preventive: You're perfectly healthy and just confirming it.
The actual definition of preventive: Catching problems early to prevent worse outcomes.
These definitions are opposites.
So yes, preventive care is free. As long as you don't need any actual healthcare during your healthcare visit.
The lie isn't that preventive care is free. The lie is calling it healthcare at all.
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Note: Based on actual "free" preventive care visits and subsequent bills. Individual charges for mentioning symptoms during wellness visits may vary by how greedy your provider is.