How to get the most value from your plan’s preventive benefits

man getting checkup Monday, January 09, 2017

Getting a regular checkup is one of the best things you can do for your health. And, in most cases, your health plan covers the cost of recommended preventive care.

The Affordable Care Act (ACA) required health plans to cover many preventive services. We'll explain how to get the best value from your plan's preventive benefits and avoid unexpected costs.

What preventive benefits are covered?

The ACA lists services that your health plan will pay 100 percent. Adults, women, and children each get a different list.

Adult preventive care benefits include:

  • Blood pressure screening
  • Colon cancer screening, if you're over age 50
  • Type 2 diabetes screening, if you have high blood pressure
  • Immunizations
  • Screenings for certain sexually transmitted infections (STIs)

Preventive care benefits for women also include:

  • Anemia screening
  • Breastfeeding support and counseling for women who are pregnant or nursing
  • Birth control

Children receive preventive care benefits that include:

  • Behavioral assessments
  • Blood pressure screening
  • Height, weight, and body mass index (BMI) measurements
  • Immunizations
  • Vision screening

What preventive services aren't usually covered?

Preventive care is a major advantage of a health plan under the ACA. So you might not expect to get a bill when you go in for an annual checkup or preventive visit to your doctor.

But your doctor may recommend services that will cost you more money. Or they may perform these services without informing you that you'll pay more.

Talking about other issues that aren't preventive may result in an extra charge for an office visit.

Here are some preventive services that may come with extra costs:

  • All the covered preventive services if you don't have risk factors or if your doctor does them more often than recommended.
  • Blood tests called a general health panel. This is a set of tests that includes your blood count and levels of various minerals and hormones in your blood.
  • Vitamin D test. Doctors may recommend a vitamin D supplement if it could benefit you, even without this test. So you may want to consider this route.
  • Skin exam or skin cancer screening. Your doctor may recommend this if your exposure to the sun puts you at risk or if you have certain warning signs. But it will still cost extra.
  • Adult eye exam (unless you have vision coverage).

How can you avoid extra costs for preventive care?

  1. Make sure your doctor is in your health plan's network. Use Premera's Find a Doctor tool if you're a Premera customer or ask when you make an appointment. Different plans may include different doctors. Yes, even if the plans are through the same company. Your ID card includes the name of your plan's specific network.
  2. Be clear when you schedule a doctor visit. Let them know you're only interested in free preventive services.
  3. Don't be afraid to ask questions about costs. Ask for more information about recommended tests or treatment based on your results.
  4. Some plans only cover preventive services 100 percent during your annual preventive checkup. So print this list from and use it to make sure you don't miss anything.
  5. Make sure your doctor uses a lab that is in your health plan's network. Sometimes your doctor may send test results to an out-of-network lab. You won't know unless you ask.

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