Under most plans, you qualify for preventive care with no out-of-pocket charge to you when you use an in-network provider. This could consist of a pap test, breast exam, evaluation of birth control needs, and screening tests. Keep in mind that if your provider performs tests based on signs or symptoms, your visit could be billed as diagnostic rather than preventive care, which means you could be charged for additional services.
Don't worry about scheduling preventive exams 365 days apart. You can have your preventive care anytime in the plan year.
If you're sexually active or thinking about becoming sexually active, it's time to schedule a gynecological exam, and then every year after that. To find a doctor, nurse practitioner, naturopath, or other provider in your specific network, sign in and use the Find a Doctor tool.
At this appointment, expect your healthcare provider to ask some questions that might be sensitive, but they are important in evaluating your health and all conversation is confidential. Your doctor might ask about family history, drug and alcohol use, sexual preferences (including how many partners you've had and if you prefer men, women, or both), and if you feel unsafe at home.
You can also discuss contraception and sexually transmitted disease protection and any other concerns you might have with your doctor.
Use the Find a Doctor tool to make sure the lab your doctor uses is in network. We recommend bringing a list or the Premera app to your appointment to confirm with your doctor. Sometimes labs are out of your area.
Your doctor might perform a pap smear test, which screens for abnormal cell changes that increase the risk of cervical cancer. Current medical guidelines recommend pap smears starting at age 21, and then every 3 years after that, if they continue to be normal. Your health plan covers pap smears as preventive at the frequency ordered by your healthcare provider.
At the same appointment, doctors might test for human papillomavirus (HPV) and chlamydia. Both are covered as preventive benefits. The Center for Disease Control recommends that girls and boys get the HPV vaccine as early as age 9. It is covered as preventive care for males and females ages 9 to 26 under most health plans. The purpose is to help vaccinate against the most common viruses that can cause cervical cancer. Girls should be vaccinated before they're sexually active.
National guidelines recommend beginning osteoporosis screenings at age 65, though you might have a test at a younger age to set a baseline. Talk to your doctor about screenings if you believe you're at risk.
Your physical exam will vary based on your age and risk. Your health plan allows you and your doctor to determine which tests are best for you and which you can skip. Procedures and tests that qualify as preventive care can include:
Keep in mind, though, that if your doctor orders follow-up procedures, those are likely billed as diagnostic rather than preventive and would not qualify as a free preventive exam.
Screenings for sexually transmitted diseases are not the same for men and women. Some tests can fall under diagnostic rather than preventive, which would be billed differently.
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Benefits under your health plan may differ, so refer to your benefit booklet for information on what your specific health plan covers.
Your health plan covers preventive care services as required by state and federal law. For more information, please review the "A" and "B" rated services on the United States Preventive Task Force, immunizations recommended by the Centers for Disease Control and Prevention and preventive care and screening recommended by the Health Resources and Services Administration. See the list on healthcare.gov.
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