In this guide
The Affordable Care Act makes the screenings with the strongest evidence free for most insured Americans. A "thorough" checkup adds tests that aren't on that list, and those are paid in cash. If you're uninsured, or haven't met a high deductible, you may pay for all of it. One top US clinic's self-pay checkup comes to about $3,400–3,600 before a colonoscopy.
What the ACA actually makes free
Under the ACA, most private health plans must cover preventive services rated A or B by the US Preventive Services Task Force (USPSTF), with no copay, coinsurance or deductible, as long as you use an in-network provider.
The Supreme Court upheld this rule in Kennedy v. Braidwood on 27 June 2025. The same ruling confirmed that the Secretary of Health and Human Services controls the task force, which matters for what stays free in future (see our guide on the USPSTF overhaul).
Examples of A- or B-rated screenings, each for specific ages and risk groups:
- Blood pressure screening for adults
- Colorectal cancer screening from age 45 to 75
- Mammograms every two years from age 40 to 74
- Diabetes screening for adults aged 35 to 70 with overweight or obesity
- Lung cancer screening with low-dose CT for adults aged 50 to 80 with a heavy smoking history
Each example was checked against the task force’s list of A and B recommendations in October 2026.
What it doesn't make free
A "thorough" or "executive" checkup usually adds tests that aren't A- or B-rated for most people, or aren't rated at all:
- Exercise stress tests for people without symptoms
- Whole-body MRI or CT scans
- Broad panels of tumor-marker blood tests
- CT scans for people who don't meet screening criteria
- Body-composition, fitness and coaching sessions
These may be useful for some people. But insurance won't treat them as free preventive care, so you pay their cash price.
What those extras cost in the US
Cleveland Clinic publishes a self-pay schedule for its executive health program. Its 2024 prices include:
| Item | Self-pay price (2024) |
|---|---|
| Base visit, history, physical and report | $1,346 |
| Laboratory panel | $256 (women) / $323 (men) |
| Spirometry | $330 |
| Exercise stress test | $860 |
| Low-dose lung CT | $275 |
| Coronary calcium score | $45 |
| Screening colonoscopy | $3,070 |
Adding up its recommended core services gives about $3,440 for women and $3,560 for men, before age-based add-ons or a colonoscopy. These prices are discounted for self-payers and can't be billed to insurance.
Who actually pays what
The gap isn't simply "free vs expensive." It depends on your coverage:
| Your situation | Guideline screenings | Extras | What drives your cost |
|---|---|---|---|
| Insured, deductible met or low | Usually $0 in-network | Cash or cost-sharing | Extras and speed |
| Insured, high deductible not met | Usually $0 in-network | Often full price until the deductible is met | Extras, plus anything coded as diagnostic |
| Uninsured or self-pay | Full price | Full price | Everything |
The coding catch
"Free" applies to screening. If a test is billed as diagnostic, because of symptoms, your history or a previous finding, normal cost-sharing can apply. KFF Health News reported a patient whose first colonoscopy cost $0 and whose second cost $2,185. Before booking, ask: "Will this be billed as screening or diagnostic?"
What this means if you're considering a checkup abroad
- If you're insured, do your guideline screenings at home, where they're likely free. The savings abroad are on extras and speed.
- If you're uninsured or self-pay, the full price gap applies, and a checkup abroad can cost much less than US cash prices. Add flights, hotel and time to any comparison.
- Either way, ask your doctor which tests fit your age and history before you pay for any package.
Questions to ask your doctor
- Which screenings am I due for, given my age and history?
- Which extras would you skip, and why?
- Will anything I'm planning be billed as diagnostic rather than screening?
Sources
- NFP: Supreme Court upholds ACA preventive care requirements nfp.com
- USPSTF: A and B recommendations uspreventiveservicestaskforce.org
- Cleveland Clinic Executive Health: 2024 self-pay fee schedule my.clevelandclinic.org
- KFF Health News: colonoscopy, screening vs diagnosis kffhealthnews.org
Please note. General information, not medical, legal or insurance advice. Ask your own doctor about your care.
Reviewed at least every three monthsNo paid placementsInformation, not medical adviceOur editorial standards
Joe Yang, PhD, Economics. Joe Yang holds a PhD in economics from the University of Washington. For four years Joe evaluated the costs and savings of US health programs for insurers and employers at a health-analytics company, and before that studied pricing and demand as an economist at Amazon and a data scientist at Oracle. These guides apply the same discipline to a simpler question: what care really costs, and where.
