Do You Know What Screenings are Covered by Most Insurance Plans?

You may think that you only really need to see a doctor when you’re sick, but it can be just as important to see a doctor when you feel completely healthy. Preventive screenings, which is when a doctor performs tests and checks for signs of serious disease often before you notice symptoms, can help you stop a disease in its tracks, get an early diagnosis, improve your outcome and keep your future health care costs down. In fact, chronic diseases that can be caught early with appropriate screenings (diseases like heart disease, cancer and diabetes) account for 75 percent of the nation’s health spending, according to the Centers for Disease Control.

Because preventive care is so important, the Affordable Care Act requires that most healthcare plans cover certain preventive services without charging you a copayment or coinsurance, if the service is provided by an in-network physician. This is true even if you haven’t met your yearly deductible.

Here is a list of some of the screenings and other preventive services that are covered under most plans if performed by your in-network provider:

  • Blood Pressure
  • Cholesterol (for adults over certain ages or at a higher risk)
  • Depression
  • Type 2 Diabetes (if you are an adult with high blood pressure)
  • Abdominal aortic aneurysms (one time screening for men who have smoked and are between the ages of 65 and 75)
  • Alcohol misuse screenings and counseling
  • Colorectal Cancer screening (for adults over 50)
  • Hepatitis C screening (for adults at a higher risk or one time for anyone born between 1945 and 1965)
  • HIV screening (for people between the ages of 15 and 65 or others with an increased risk)
  • Lung cancer (for adults aged 55 to 80 who are either heavy smokers or quit in the past 15 years)
  • Tobacco use screening and cessation interventions
  • Gestational diabetes screenings for women during pregnancy

While these screenings typically come at no cost to you, there are certain circumstances where insurers may still charge a copay or other type of cost sharing when paying for preventive services:

  • If the screening or preventive service and the office visit are billed separately, the insurer may apply a cost share to the office visit.
  • If they are not billed separately, and the primary reason for the visit was not to provide a screening or preventive service, patients may have to pay a cost share for the office visit.
  • If the screening or preventive service is performed by an out-of-network provider, insurers may require a cost share for the visit and the preventive service, unless an in-network provider was not available.

If you’d like to learn more about screenings and preventive care, you may find these blogs helpful:

Photo credit: Maryland GovPics

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