Regular check-ups, screenings and immunizations are some of the best ways to help keep you and your family healthy. This type of health care, called preventive care, may also help you catch any health problems before they become serious. Talk to your doctor about what care is right for you and see what’s recommended for your age and gender:*
* PLEASE NOTE: A recommendation or discussion with your doctor does not guarantee coverage or a certain level of coverage.
How health plans cover preventive care
Most health plans cover preventive care without applying a copay, coinsurance or deductible when you see a doctor that’s in your network and meet certain requirements.
Some services may not be covered
Be sure to check the details of your plan before you make an appointment with a doctor. Some health plans may not cover preventive services or have varying levels of coverage.
Sometimes, your doctor will order tests during your preventive care visit that are not preventive care. These tests may be subject to deductibles, copays and/or coinsurance. Your doctor may also treat an existing condition (or you may have symptoms of an illness at the time of your visit). Treatment or tests for that existing condition are not preventive care and are subject to deductibles, copays and/or coinsurance.
Here is a list of preventive care services that many health plans cover:
Preventive care for women
Some preventive care is just for women, like mammograms and Pap tests. If you’re a woman, your health plan may cover some preventive tests that weren’t covered by your health plan before the Affordable Care Act. This does not apply to all health plans. Call the number on the back of your member ID card to find out if your health plan covers these services.
For a list of women’s preventive contraceptive benefits that may be covered by Blue Cross, see:
Be sure you understand what is covered by your health plan before you make an appointment with your doctor. Call the number on the back of your member ID card for information about how your health plan pays for preventive care.
It’s important your doctor's office submits a claim to your health plan that clearly shows whether you received covered preventive care. The provider is responsible for complete and accurate coding that reflects the services provided.