What’s preventive care and what’s covered?
When it comes to your health, there’s no such thing as starting too early. Eating whole, nutritious foods, staying active, limiting alcohol, managing stress and getting routine checkups are all part of your preventive care.
Think of preventive care appointments like car maintenance. You likely bring your car in regularly for an oil check, tire rotation and break inspection to catch any issues and help keep your car running smoothly for as long as possible. Preventive care is routine health care that helps you stay on top of your health — and catch anything before it becomes serious.
What’s considered preventive care?
Preventive care includes the services you get as part of your routine well exam. Most health plans cover eligible preventive care services, which means you’ll pay $0 out of pocket. Preventive care includes:
- Your annual physical care exam
- Vaccines
- Well-baby and well-child care
- Recommended cancer tests and screenings at certain ages for skin, breast, colon, prostate, lung and cervical cancer
- Other health screenings for things like osteoporosis and diabetes
Get a preventive care checklist
Wondering what to expect at your appointment? Enter your information to see a checklist of common tests and screenings for your age and gender.
What’s not considered preventive care?
There are times when certain tests and screenings aren’t considered preventive care. Things like diagnostic care, bloodwork and sexually transmitted infection (STI) testing may or may not be considered preventive.
Health plans cover preventive and diagnostic care differently. It’s important to know which services fall into each category so you can budget. Diagnostic care includes care or treatment when you already have symptoms or risk factors and your doctor wants to diagnose them. For example, if a woman finds a lump in her breast and gets a mammogram, that screening is considered a diagnostic mammogram instead of a preventive mammogram.
Labs are an important part of your health care. Labs done during or as part of your well exam, including a complete blood count (CBC) and bloodwork used to check cholesterol levels and diabetes markers are likely always going to be covered. However, other blood chemistry tests (like kidney or liver function and vitamin D or iron levels) are not considered preventive care.
Certain STI tests, like HIV, hepatitis B and C and syphilis are considered preventive for people at certain ages or with specific risk factors. Ask your doctor which STI tests may be covered as part of your preventive care visit.
What to expect at preventive care exams
You might be wondering where to get a physical exam. Typically, you’ll see your primary care provider (PCP) for your annual checkup. You can see any provider you’d like as long as they’re in your plan’s network. Otherwise, you may pay out of pocket for your preventive care visit. So, what is in a physical exam? Each person’s visit will look a little different, but here’s what you can expect.
Height, weight and body mass index (BMI) assessment
Your Body Mass Index (BMI) is an estimate of your body mass based on your height and weight. It can help you determine if you’re at a healthy weight.
Heart rate check and heart exam
A healthy resting heart rate for adults is typically between 60 and 100 beats per minute (bpm).4 During a heart exam, your doctor listens to your heart with a stethoscope to check for signs of heart disease, like an irregular heartbeat or murmur.
Lab work
Regular lab work can help you and your doctor understand how well your body is functioning. Ask your doctor which tests are considered preventive (like cholesterol and blood glucose) and which you may have to pay for out of pocket (like a thyroid panel).
Blood pressure test
Normal blood pressure is considered 120/80 mm Hg (millimeters of mercury) or less.3 It’s important to know your numbers so you can keep your blood pressure in check.
Lung exam
Like a heart exam, lungs are checked for signs of disease, like wheezing or crackling.
Cancer screenings for adults
Common cancer screenings are recommended based on your age and risk factors.
Vaccines
Recommendations depend on your age and other factors. Some, like the flu shot, are recommended annually.5 See more about immunizations from the Centers for Disease Control and Prevention.
How can I prepare for my preventive care visit?
Make the most of the time you have with your provider during your annual checkup. Use these checklists to come prepared, and leave feeling confident and informed.
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Your member ID card and a photo ID (like your driver’s license).
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A list of your medications, including over-the-counter products, prescriptions, vitamins and supplements you currently take. Some medicines and even "natural" products can interact with each other, which can be dangerous.
Quick tip: Bring your bottles and containers in a bag if it's easier than making a list.
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Health history with details about your family medical history as well as your personal health history.
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Questions, concerns and any symptoms you're experiencing.
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A family member or friend. (They can help make sure you catch all the details.)
Quick tip: Jot down important information on a notepad or on your phone. Ask your doctor for a copy of your appointment notes.
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What screenings, tests or vaccines do you recommend?
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When will I get my test results from this visit?
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Does my family history raise my risk for any health problems?
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Are there steps I can take to improve my health?
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Do you have follow-up instructions for me? Can I get a copy?
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When should I schedule my next appointment?
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How can I contact you if I have questions after my visit?
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When should I get a mammogram to screen for breast cancer? Should I consider genetic testing?
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When should I get screened for cervical cancer?
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When should I get screened for colorectal cancer? What are the benefits and risks of the different tests?
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Should I get tested for sexually transmitted infections?
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Should I get a prostate cancer screening?
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How often should I check my cholesterol? What should my levels be?
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How often should I check my blood pressure? What should my numbers be?
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How often should I get screened for diabetes?
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Do I need a bone density test?
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What other important screenings do you recommend?
You may have additional tests and screenings based on your age or health.