How to avoid surprise costs for preventive health services

Avoid surprise costs for preventive care Tuesday, November 01, 2016

The Affordable Care Act (ACA) requires your insurance to cover the cost of many preventive services. That should mean you don't pay anything extra, even if you haven't met your deductible. But a trip to the doctor for preventive care sometimes comes with surprise costs.

To help you avoid those unpleasant surprises, we'll explain how to find out what services are free. And we'll tell you what your doctor might recommend that's not free.

What's included when it comes to preventive services?

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)

Extra preventive care benefits for women 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 free?

Preventive care is a major advantage of an individual health plan under the ACA. So you probably don't 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 at your preventive visit, without informing you that you'll pay more.

Discussion about other issues that are not preventive (such as asking about a hurt knee), may result in an additional charge for an office visit.
Here are some preventive services that may come with surprise 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 calcium, potassium, thyroid stimulating hormone, and bilirubin 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 surprise costs before you get a bill?

  1. Make sure your doctor is in your health plan's network. Use Premera's Find a Doctor tool or ask when you make an appointment. Different plans may include different doctors, 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. You should ask for more information if your doctor recommends tests or says you need treatment based on your results.
  4. Preventive services may only be covered 100 percent if they happen 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.

Have you received a surprise bill from a preventive checkup? Do you have advice to help others avoid surprise costs? Share your experience on our Facebook page

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