Preventative Care

What are preventive care services?

• Annual check-up (1 per calendar year): This is when your Primary Care Provider (PCP) checks all areas of your health—physical, as well as emotional. This can help detect any health concerns early, before they become major medical problems.
• Flu shot (1 per year): This is typically covered 100% under most health plans and helps protect you from certain strains of the flu virus.
• Mammogram (1 per calendar year, usually after the age of 40): Routine X-rays of breast tissue to check for any signs of cancer or other abnormalities. Some health plans may also cover costs for 3D imaging.
• Colonoscopy (typically 1 per every 10 years, usually after the age of 50): Screening for colon cancer.
• Vaccinations (usually administered during childhood, includes boosters as needed): Vaccinations like measles, mumps, rubella, polio, etc. are covered 100%.

Examples of non-preventive care include:

• Diagnostic tests and screenings: These are not routine tests and screenings. For example, if your radiologist finds something on your mammogram and wants another, it’s considered a diagnostic mammogram and will typically not be covered as preventive care.
• Additional primary care visits: Most health plans will cover you for 1 annual check-up with your doctor. Other visits during the same calendar year will likely not be covered as preventive. For example, let’s say you have flu symptoms and need to see your doctor—that’s not a covered preventive care visit.
• Specialist visits: Visits to a specialist (gastroenterologist, orthopedist, neurologist, podiatrist, etc.) for a particular problem are not covered as preventive care.
• Alternative therapies: Services such as chiropractic, massage, acupuncture, and other alternative health services are not considered preventive care.
• PSA blood test: This is a test to check for prostate cancer. Some health plans may cover this as preventive care, but many do not.