Your health plan probably covers more than you think. Under the Affordable Care Act (ACA), most private insurance plans must cover a set of preventive services at $0 cost (no copay, no coinsurance, no deductible) when you use an in-network provider. Medicare covers most of the same screenings and vaccines at no cost under its own rules. Grandfathered plans are exempt from the ACA requirement. The idea was to shift from treating sickness to keeping people well. Yet awareness and use remain low. A strong benefits strategy lists these services and actively pushes people to use them.
The Core Categories of ACA-Mandated Preventive Care
The required preventive services come from independent expert bodies, including the U.S. Preventive Services Task Force, the Advisory Committee on Immunization Practices, the Health Resources and Services Administration for women's services, and Bright Futures guidelines for children. They fall into three categories for adults, plus separate guidelines for women and children.
For All Adults
- Screenings: Blood pressure, cholesterol, diabetes, colorectal cancer (starting at 45), lung cancer (for adults 50 to 80 with a heavy smoking history), and depression.
- Immunizations: Flu shots, tetanus boosters, the shingles vaccine for adults 50 and older, and COVID-19 vaccines.
- Counseling: For quitting tobacco, losing weight, reducing alcohol use, and preventing STIs.
For Women (Including Pregnant Individuals)
- Well-Woman Visits: Annual check-ups that focus on preventive care.
- Screenings: Mammograms, Pap smears, osteoporosis tests, and gestational diabetes screening.
- Support: Breastfeeding help, contraception, and domestic violence screening.
For Children
- Developmental & Behavioral Screenings: From infancy through the teen years.
- Immunizations: Following the recommended schedule.
- Screenings: For autism, vision, hearing, obesity, and depression.
The Supreme Court Upheld the Coverage Mandate in 2025
For two years, employers had reason to wonder whether the $0-cost rule would survive. A group of Texas employers and individuals challenged the mandate in Braidwood v. Becerra, arguing that the U.S. Preventive Services Task Force's members were improperly appointed. A district judge blocked the USPSTF-based requirement in March 2023, and the Fifth Circuit later narrowed that ruling to the plaintiffs in the case. On June 27, 2025, the Supreme Court resolved the challenge in Kennedy v. Braidwood, holding that the Task Force's appointment structure is constitutional. The $0-cost requirement stands. Employers can build engagement programs on top of it without waiting on the courts.
Why Coverage Alone Isn't Enough
Coverage is broad. Utilization lags. People skip covered services because they don't know what counts as preventive, they worry a no-cost screening will turn into a surprise bill, or they never get a clear nudge from their plan. The result is that employers pay for prevention that never happens, then pay again for the illness it could have caught. For benefits pros, this gap is the biggest opportunity to improve health and cut claims. The fix is to make prevention automatic, rewarding, and tied to long-term financial wellness.
A Modern Approach: Turning Prevention into Automatic Wealth
Forward-thinking companies are building systems that connect health actions to financial outcomes. That's the core of the Health-to-Wealth™ model. WellthCare™, the first Health-to-Wealth Benefit System, puts the idea into practice by rewarding employees for the verified preventive actions they take, pairing immediate spending power with automatic retirement growth. The system works through three connected steps:
- Instant incentives drive usage. Employees earn reward dollars for screenings, check-ups, and other verified preventive actions, spendable right away at the WellthCare Store™.
- Data keeps it personal. A patent-pending platform tracks each person's verified actions, builds an AI-drafted plan of care reviewed by a nurse practitioner and physician, and keeps compliance-grade records in the background.
- Wealth compounds over time. Verified preventive actions trigger automatic retirement contributions. Today's check-up builds tomorrow's balance.
This system sets up a win for both sides. Employees get $0-co-pay care, reward dollars in the WellthCare Store, and automatic retirement contributions. Employers see fewer claims, lower costs, and higher retention. It turns the ACA's mandate from a static list into a health and wealth routine employees use.
Your plan covers these services at no cost. If nobody uses them, that coverage buys nothing. The real work for HR leaders is getting people to show up. Tie prevention to reward dollars and retirement savings, and engagement climbs. Prevention becomes the foundation of a healthier, wealthier workforce. See what a WellthCare Plan would look like for your team.
This article is for general information only and is not legal, tax, or medical advice. Employers should consult their own advisors.