If you haven’t scheduled your annual exam and preventive screenings for this year, there’s no better time than now. Getting your yearly wellness checkup and taking advantage of preventive care services can help catch health problems early.
And the Centers for Disease Control and Prevention says getting the right health services, including vaccines, screenings and treatments, helps your chances for living a longer, healthier life.
One added benefit you may not know about — it may save you money.
What Is an Annual Exam?
An annual preventive care exam isn’t the same as other visits to the doctor.
The annual exam involves preventive care services like checkups, screenings and immunizations. It is only scheduled once a year and isn’t tied to any health problem or chronic condition that you may see your doctor for at other times.
There is no copay, deductible or coinsurance when you visit a provider in your health plan’s network for a preventive service.* That is, you pay nothing beyond the pre-tax amount you pay in your paychecks. Well-child visits can take place a few times each year based on recommendations and have no copay.
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, often called sick visits, it isn’t a preventive exam. You may owe a copay or coinsurance for this type of 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 fit for all people. Some apply just in certain age ranges. Some apply only to women or men.
Others may apply based on family history or risks that are common to your habits of daily life. These factors include things like your diet, if 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 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 tests.
It may seem like you’re going through the same motions if you must 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.
One example is a colonoscopy. 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 group of cells (polyps). This screening is important because not all early problems cause symptoms. Catching and treating issues early can make a big difference in how successful treatment is. Treating your health problem early may also cost less.
If a polyp is found and removed during a screening colonoscopy, the test should still be billed as a screening. But if you have the test because you have had warnings like pain or blood in the stool, the test is considered diagnostic. It is needed to diagnose your problem. Out-of-pocket costs may be higher with a diagnostic test.
Mammograms are one of the more common examples 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.
Diagnostic mammograms are ordered when there are symptoms or when the screening mammogram shows an area of concern. Other doctors may need to look at the results while the test is being done. And more images and even ultrasounds may be needed.
A diagnostic mammogram is more involved and may cost more than a screening mammogram.
Sometimes, a technician prepping you for a test may ask if you are having a screening or diagnostic version of the test. It’s OK 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.*
Source: Regular Check-ups are Important, Centers for Disease Control and Prevention, 2017
*Preventive services at no cost applies only to members enrolled in non-grandfathered health plans. You may have to pay all or part of the cost of preventive care if your health plan is grandfathered. To find out if your plan is grandfathered or non-grandfathered, call the customer service number on your member ID card.