Should I Have Paid for This Preventive Care?
Whether a private plan may charge cost sharing for a preventive service, citing the federal rule or FAQ that decides it.
Open the tool → Runs in your browser. Data leaves only if you deliberately send a problem report from the interactive tool.
Example
- Kind of plan
- Employer or individual (Marketplace) plan, not grandfathered
- What was charged for
- Colonoscopy after a positive stool test (FIT, Cologuard) or…
- In network or not
- In network
Result: Cost sharing is not allowed for the follow-up colonoscopy, which completes the screening (for plan years beginning on or after May 31, 2022) (FAQs about ACA Implementation Part 51 (Jan. 10, 2022), Q7 and Q8).
The tool opens with these values already filled in. Replace them with your own.
What you enter
- Kind of plan
- What was charged for
- In network or not
- Office visit billed separately
- Visit mainly for the preventive service
- Amount charged
How this is calculated
Citation
PHS Act 2713; 45 CFR 147.130(a)(2)-(3) and 147.140; FAQs about ACA Implementation Parts XII (2013) Q5, XXVI (2015) Q7, XXIX (2015) Q7-Q8, 31 (2016) Q1, 47 (2021) and 51 (2022) Q7-Q9. Read the sources: 45 CFR 147.130 ↗, FAQs Part 51 (Jan. 10, 2022) ↗, FAQs Part 47 (July 19, 2021) ↗, FAQs Part XII (Feb. 20, 2013) ↗
A reference and educational tool. Not medical, legal, or financial advice, and not a substitute for clinician judgment.