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Preventive care

Preventive care helps you find or prevent serious health conditions before they become a bigger problem. Annual visits with your primary care doctor, immunizations/flu shots and certain age-related tests and screenings are examples of preventive care.

Most health plans cover eligible preventive care services at 100 percent, but your primary care doctor must be in-network to be covered in full. And each plan’s preventive care services may be different, so talk to your doctor about what’s covered and not covered and when you should have certain tests or screenings done.

What are preventive services?

  • Annual wellness visit (one per year): Your primary care doctor checks all areas of your health and compares it to past years.
  • Flu shot (one per year): Most health plans cover a flu shot at 100 percent, which protects you from strains of the flu.
  • Mammogram (one per year, usually after age 40): Routine X-rays to check for any signs of cancer or other abnormalities.
  • Colonoscopy (one every 10 years, usually after age 45): Routine screening for colon cancer.
  • Vaccination (childhood): Immunization for measles, mumps, rubella, polio and more covered at 100 percent.

What’s the difference between preventive care and diagnostic tests?

Preventive screenings look for diseases or conditions before there are symptoms or signs. These occur at certain ages. The idea is when you catch and treat a disease early it will be easier to manage or eliminate. Preventive screenings play an important role in protecting your health and many are covered at no cost to you under your plan.

Diagnostic tests are done when you and your doctor know you have a health problem and you need to know the cause. As an example, women get regular mammograms as a preventive screening. If something is found in a preventive screening mammogram, the screening is still at no cost to the member. However, if her doctor schedules a follow up mammogram six months later to re-examine that change, it would be used to diagnose a symptom and wouldn’t be preventive.

Ways to save on preventive care benefits

  • The easiest way to find out what preventive screenings your health plan covers is to call the customer service number on your member ID card before you go to the doctor. You can find out what screenings are available to you based on your age.
  • If your primary care doctor suggests a “screening” you think might not be covered, ask if there is a reason for the test to be done. You may need the test, but if you have a symptom, it will be diagnostic.
  • Make sure you visit doctors who are in our network to get free or low-cost preventive healthcare. If your preventive screenings turn up a health issue and you need to see a specialist, make sure your doctor recommends a specialist who is also in our network. You can find out if a doctor is in our networks by using our find care tool or calling the customer service number on the back of your ID card.

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