If you haven’t scheduled your annual exam and preventive screenings for this year, there’s no better time than now.
Getting your annual wellness check-up and taking advantage of preventive care services can help catch health problems early before they become serious. And it can save you money.
There are a few important things you should keep in mind as you use your preventive care services benefits.
What Is an Annual Exam?
It’s important to know that there is a difference between an annual exam and other visits to the doctor.
The annual exam includes preventive care services like annual check-ups, screenings and immunizations. There is no copay, deductible or coinsurance when you visit a provider in your health plan’s network.* That is, you pay nothing beyond the premium you paid for your coverage for the annual exam visit or for covered tests.
What if you need to go to the doctor again during the same year? Maybe you are worried about your health. Or you think you might have the flu. Or maybe you just get an odd pain or notice changes in your body during your normal routine.
When you make an appointment for these types of visits, be aware it is NOT part of your annual exam preventive services coverage. So you may owe a copay or coinsurance for a primary care doctor visit, depending on your coverage.
Are All Annual Screening Tests Meant for Everyone?
The short answer is “No.” An annual exam includes a list of things your doctor may review. Some of these things apply to everyone. Some apply just in certain age ranges. Some apply only to women or men.
Others apply based on family history or risks that are common to your habits of daily life. These include things like your diet, whether you smoke or if you have a family history of a certain disease.
It’s important to ask your doctor about the tests you’re asked to take and how you fit the rules for each test. Then you can find out which tests you take will or won’t be covered by your health plan.
What’s the Difference Between a Screening Test and a Diagnostic Test?
Some tests on that annual exam list come in two forms — screening and diagnostic. Think of them as “regular” and “extra strength” versions.
Those extra strength diagnostic tests may use different tools. They may even need review by different specialists than the regular kind.
It may seem like you’re going through the same motions if you have to have both types. But the different tests tell your doctor different things. The different types of tests can also make a difference in how much the tests cost.
Take the colonoscopy, for example. When you turn 50, you may need to get a colonoscopy. If you have a family history of colon cancer you might need a colonoscopy sooner.
A colonoscopy involves a doctor guiding a camera through your colon looking for any unusual tissue (polyps).
This screening is important because not all early problems cause symptoms. Catching and treating problems early can make a big difference in how successful treatment is. Treating your condition early may also be less expensive.
If a polyp is found and removed during a screening colonoscopy, the test should still be billed as a screening. Follow-up “surveillance” colonoscopies are also screening tests.
But if you have the test because you have had symptoms like pain or blood in the stool, the test becomes diagnostic. Out-of-pocket costs may be higher with a diagnostic test.
Mammograms are another common example of the difference between screening and diagnostic tests.
Based on age and family history, women may get a screening mammogram every year or every other year.** That’s if they have never had any lumps, and they have no pain or other symptoms.
A diagnostic mammogram is more involved and may cost more than a screening mammogram.
Diagnostic mammograms are ordered when there are symptoms or when the screening mammogram shows an area of concern. Other providers may need to look at the results while the test is being done. And more images and even ultrasounds may be needed.
Sometimes, a technician preparing you for a test like a colonoscopy or mammogram may ask if you are having a screening or diagnostic version of the test. It’s okay if you don’t know. Just ask the technician to check with your doctor.
You can call customer service at the number on your member ID card to find out what benefits are covered under your plan, including those covered at no cost to you.
*Check your insurance benefits or call customer service at the number listed on your ID card to find out if preventive care services are covered at no out-of-pocket cost to you. Coverage may differ based on the type of health plan you have.
**The recommendation for when and how often screening mammograms are ordered may change based on recent studies.