Is a depression screening supposed to be free?

A: For most people on most plans, yes — no copay, no coinsurance, no deductible. Federal law requires non-grandfathered health plans to cover, with no cost sharing, any service the U.S. Preventive Services Task Force rates A or B.¹ Depression screening in adults, including during pregnancy and after, is rated B.² So is anxiety screening in adults up to age 64, depression screening in adolescents 12 to 18, and anxiety screening in children and adolescents 8 to 18.² That covers the PHQ-9 and GAD-7 conversation with a primary care doctor for most Californians.

The four gaps, because the mandate follows the letter grade. Suicide-risk screening at any age, anxiety screening at 65 and over, depression screening in children 11 and under, and anxiety screening in children 7 and under all carry an I rating — insufficient evidence — and an I rating creates no coverage requirement at all.² Your plan may still cover them. It is not obliged to.

California is better than federal law here, in two specific ways. State law pegs the no-cost-sharing list to the A and B recommendations in effect on 1 January 2025 rather than to whatever the federal task force says next, and it bars cost sharing for anything "integral to" a required preventive service regardless of whether the integral item is billed separately — which is broader than the federal rule.³

Where the bill comes from anyway. Two rules, both worth knowing before you argue. First, if the screening is billed separately from the office visit, the plan may charge you for the visit.⁴ If the screening is not billed separately and the main purpose of the visit was the screening, it may not.⁴ Second, whatever the screening finds is a different question: treatment that follows is ordinary covered care with ordinary cost sharing.⁵ And if the bill looks like it came from how the claim was coded rather than from what you received, federal regulators have said plainly that plans should not impose cost sharing based on coding alone, without individualised information showing the service was not a recommended preventive service.⁶

Worked example: you book a visit specifically to talk about low mood, the doctor screens you with the PHQ-9, and the claim comes back with a $40 charge for the office visit. Ask two questions: was the screening billed as a separate line, and what was the primary purpose of the visit on the record? If the visit existed for the screening and no separate line was billed, the charge is the thing to dispute.

Two exceptions to all of this. Grandfathered plans — the same plan someone has been enrolled in since March 2010 — are exempt from the preventive rule entirely, and the law makes them say so in their materials.⁷ Medicare runs its own benefit: one depression screening per 12 months, up to 15 minutes, paid at 100% with no deductible, where the practice has follow-up supports in place.⁸

Do this: when you book, say the words "annual depression screening" rather than "I want to talk about my mood," and ask the front desk to bill it as preventive. If a bill arrives anyway, ask the plan for the claim's coding and whether the screening was billed separately — then appeal. The free version you can do first, on your own device →

Sources

1. Public Health Service Act §2713, 42 U.S.C. §300gg-13(a)(1): a plan or issuer "shall, at a minimum provide coverage for and shall not impose any cost sharing requirements for… evidence-based items or services that have in effect a rating of 'A' or 'B' in the current recommendations of the United States Preventive Services Task Force" — uscode.house.gov. Implementing regulation 45 C.F.R. §147.130 — ecfr.gov. New recommendations apply for plan years beginning at least one year after they are issued (§147.130(b)(1)).
2. U.S. Preventive Services Task Force A and B recommendations, checked 17 August 2026: depression in adults, including pregnant and postpartum persons and adults 65 and older — B, 20 June 2023, with suicide-risk screening in the same statement rated I; anxiety in adults 64 and younger — B, 20 June 2023, with 65 and older rated I; depression in adolescents 12–18 — B, 11 October 2022, with children 11 and under rated I; anxiety in children and adolescents 8–18 — B, 11 October 2022, with children 7 and under rated I — uspreventiveservicestaskforce.org. Only A and B ratings carry the coverage requirement (45 C.F.R. §147.130(a)(1)(i), (a)(5)).
3. Health & Safety Code §1367.002 and Insurance Code §10112.2, as amended by AB 144 (Stats. 2025, Ch. 105), effective 17 September 2025 — the list is fixed to the A and B recommendations "in effect on January 1, 2025," subject to modification published under Health & Safety Code §120164, and subdivision (a)(5)(B) bars cost sharing for services "integral to" a covered preventive service "regardless of whether or not the integral item or service is billed separately." The integral-services and office-visit provisions were added by AB 2258 (Stats. 2024, Ch. 708) — leginfo.legislature.ca.gov.
4. 45 C.F.R. §147.130(a)(2)(i)–(iii), and the parallel California rule at Health & Safety Code §1367.002(a)(6).
5. 45 C.F.R. §147.130(a)(5): a plan "may impose cost-sharing requirements for a treatment not described in paragraph (a)(1)… even if the treatment results from" a covered preventive service.
6. FAQs About Affordable Care Act Implementation Part 68, U.S. Departments of Labor, Health & Human Services and the Treasury, 21 October 2024, Q2 and Q4–Q6: plans "should not impose cost-sharing requirements… unless and until the plan or issuer has individualized information to establish that the furnished items or services are not recommended preventive items or services" — dol.gov.
7. 45 C.F.R. §147.130(d) and §147.140 — grandfathered plans are outside the preventive-services rule; the model disclosure at §147.140(a)(2)(ii) tells members their plan "may not include certain consumer protections of the Affordable Care Act… for example, the requirement for the provision of preventive health services without any cost sharing."
8. CMS National Coverage Determination 210.9, "Screening for Depression in Adults," effective 14 October 2011 — annual screening up to 15 minutes where staff-assisted depression care supports are in place; more than once in 12 months is nationally non-covered — cms.gov. Paid at 100% with no Part B deductible under 42 U.S.C. §1395l(a)(1)(Y) and §1395l(b)(1).

All rules checked 17 August 2026.