Your health plan pays 100% of certain preventive care services with no out-of-pocket costs to you. Preventive care is routine health care that includes screenings, checkups, and patient counseling to help prevent illnesses, disease, or other health problems.

Services Covered at 100%

Preventive care is covered at 100% when:

  • It is provided by an in-network provider,
  • The claim is filed as a preventive visit, and
  • Services are identified as preventive care under the Affordable Care Act (ACA). The ACA requires that health plans cover certain preventive services at no cost for members.

View Covered Preventive Care Services

Coverage may include some limitations. For example, some services may not be covered until you reach a certain age, or may have a limit on how frequently you can get them. Check with your health plan before getting preventive care services to avoid unexpected costs.

Before your appointment, you can ask your health plan and doctor:

  • Is my doctor in my health plan’s network?
  • What preventive care screenings and tests are covered for me at 100% with no out-of-pocket costs by my health plan?
  • Will any tests or treatments I get during my appointment not be considered preventive care, meaning that I may have out-of-pocket costs?
  • Will talking about other topics that are not considered preventive care during my appointment lead to out-of-pocket costs?

Services With Out-Of-Pocket Costs

Once a preventive screening has an abnormal result, subsequent screenings are considered diagnostic care.  Diagnostic tests and screenings are done to learn more about a suspected or known medical condition. Diagnostic care will likely have out-of-pocket costs associated with them, see your Schedule of Benefits for more information.