Get Screened Before Year-End: Use Your Health Plan’s Preventive Benefits Before They Expire

Late in the year can feel hectic. But before December slips away, take some time for your health. Many health plans reset benefits on Jan. 1. That means your preventive screening benefits  may go unused — or expire. Use your benefits before year end so you don’t lose what you’ve already paid for.

Key Takeaways: Preventive Health Benefits

• Use your health plan preventive benefits now. Most health plans reset on Jan. 1, and unused screenings don’t roll over.
• Most covered preventive services are free by law under the Affordable Care Act, when you see in-network providers.
• Check your plan and schedule early. Confirm coverage and book appointments before the year ends.
• Missing the deadline can cost you money. You might pay out-of-pocket or delay important early detection.

Which Preventive Screenings Are Covered By Law?

Federal law makes it easier and more affordable to stay healthy. Under the Affordable Care Act (ACA), most health plans must cover a wide range of covered preventive services at no cost to you when you use in-network providers.

These health plan preventive benefits are based on national medical guidelines from expert groups such as the U.S. Preventive Services Task Force (USPSTF), the U.S. Centers for Disease Control and Prevention (CDC) and the Health Resources & Services Administration (HRSA). They define which preventive screenings, vaccines and services have the strongest evidence for keeping adults, women and children healthy.

Not every adult or child qualifies for every screening. Eligibility depends on your age, health history, risk factors and the official guidelines from USPSTF, HRSA and related agencies. Some screenings, such as a mammogram, may need to be scheduled at regular intervals, such as one year plus one day apart, to be covered.

To receive these services as no-cost preventive care, your health plan must be non-grandfathered. This means it was updated after the ACA took effect. Some older or limited plans may not include these no-cost preventive benefits, so double-check your coverage before scheduling. Even for covered preventive services, you’ll need to use in-network providers to avoid out-of-pocket costs.

Preventive services for adults

Typical ACA-mandated preventive screenings (for eligible adults) include:

• Certain sexually transmitted infections (HIV, hepatitis B and C, and syphilis)
• Colorectal cancer (colonoscopies, stool tests or flexible sigmoidoscopy)
• Depression
• High blood pressure (hypertension)
• High cholesterol (lipid disorders)
• Lung cancer (for adults ages 50–80 with a history of heavy smoking)
• Obesity and unhealthy diet counseling
• Routine immunizations (flu, COVID-19, HPV, hepatitis B, tetanus, shingles, and others recommended by the CDC)
• Type 2 diabetes (especially for adults who are overweight or have risk factors)

Men often have unique preventive needs, from cholesterol checks to prostate cancer screening. Read more in 7 Health Screenings Men Should Not Miss.

Preventive services for women

In addition to general adult services, women have extra covered preventive services mandated under the ACA, which include:

• Breastfeeding support, counseling and supplies
• Cervical cancer screening (Pap test and HPV testing)
• Contraceptive services, counseling and FDA-approved methods
• Mammography and breast cancer screening
• Screening for anxiety, STIs and HIV (as part of risk-based screening)
• Screening for domestic/intimate partner violence and urinary incontinence
• Screening for gestational diabetes in pregnancy
• Well-woman visit (annual preventive check)

Preventive services for children and youth

For infants, children and adolescents, the ACA requires no cost preventive care that includes:

• Dental screenings and oral health services
• Developmental and behavioral screenings
• Immunizations
• Mental health and behavioral assessments
• Screening for anemia, lead poisoning and obesity
• Vision and hearing assessments
• Well-child visits and periodic health exams

When Do Preventive Benefits Expire?

Most plans operate on a calendar year basis. That means your health plan’s preventive benefits reset on Jan. 1 each year. If you haven’t used your preventive screenings by the end of the year, you could lose those benefits.

Some screenings are only covered once every year or two. If you wait too long to schedule, your appointment might count toward next year’s benefits instead.

Medicare works a little differently. Original Medicare (Part B) covers many preventive services at no cost when you meet eligibility rules, such as annual screenings, flu shots and certain cancer tests. Medicare Advantage (Part C) plans must also include these preventive benefits under their plan rules.

If you’re new to Medicare, you can schedule a Welcome to Medicare preventive visit within your first 12 months of enrollment. After that, you qualify for a yearly wellness visit to help you plan and update your preventive care.

You can review the full list of covered preventive services in the Medicare Preventive Services guide.

How To Know If You’re Eligible

1. Check your plan documents or member portal. Look for terms like preventive services, no-cost sharing or wellness benefits.
2. Ask your HR benefits administrator. They can tell you if your employer’s health plan follows the current ACA rules and what preventive screenings it covers.
3. Contact your insurer’s member services. They can confirm which covered preventive services are offered at no cost and note any limitations, such as needing to wait 12 months before the next screening.
4. Confirm the provider is in-network. Free coverage generally applies only when using in-network providers.

What You Can Do Right Now

You still have time to make the most of your health plan’s preventive benefits. Here are simple steps you can take right now to protect your health — and your wallet — before the year ends.

• Make a list of recommended screenings based on your age, sex and health history.
• Call your primary care provider or specialist early — December fills fast.
• Ask your provider to code the appointment as a preventive screening.
• Confirm whether the service will be fully covered under your plan.
• Use any remaining benefits now — even if not perfect, partial use trumps losing them.

What Happens If I Miss The End Of The Year?

If you miss the year-end window, you could lose your chance to use this year’s covered preventive services. That means you might need to pay out of pocket or meet your deductible before your plan covers those screenings again. Delaying these visits can also put your health at risk, since missed screenings may lead to later detection of conditions. Most importantly, you lose the opportunity to use the health plan’s preventive benefits that your insurance already paid for.

The end of the year is a great time to focus on your health and make the most of your health plan’s preventive benefits. Your preventive care can help you catch small problems early, often at no cost. Don’t wait until January and risk losing these valuable opportunities. Use benefits before year end and take advantage now of your covered preventive services. Talk with your primary care provider today or find a Franciscan Health provider near you.