Need a check-up? Here’s what’s included in a preventive visit

Need a check-up? Here’s what’s included in a preventive visit—and what’s not

Jan 21, 2025

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Too many folks put off their wellness checks because they don’t feel sick and don’t think they have anything to be concerned about. And some don’t believe they can afford a simple check-up.

If it’s been a while since you’ve had a wellness visit, here’s some good news. Preventive care isn’t just about avoiding illness—it can help you stay healthy and maintain your overall well-being. And the best part? When you visit an in-network provider, your health plan covers services including screenings, checkups and healthcare counseling, many at no cost to you.

Even if you feel fine, a wellness visit helps to build an important relationship with your provider, who can give you peace of mind that you’re OK and help to create a plan to maintain your health. Without a doubt, preventive care is one of the best ways to fend off chronic illness, or discover potential issues like high blood pressure, diabetes or even cancer—often before you even feel any symptoms. You can find a list of preventive health services for all adults, children and women at healthcare.gov.

Before your appointment, you can visit Healthwise, an online resource that provides evidence-based health and wellness information, to get tips on how to make the most of your appointment.

Here’s what you’ll do at a preventive visit:

Discuss your medical history, lifestyle and any factors related to your health.
Undergo a physical exam that includes height and weight measurements and blood pressure tests. Your provider will also listen to your heart and lungs.
Update vaccines, including flu and Covid-19 shots.
Schedule preventive screenings, like lab tests to check cholesterol or blood sugar, routine mammograms, and cervical or colorectal cancer screenings.
Explore changes you can make to stay healthy, especially if you are at risk for certain conditions, given your medical history.
Update the status of chronic medical conditions and confirm that medications are up to date. (Note that many labs, testing or specialty visits to manage those conditions may not be considered preventive.)

What you might pay for

To avoid billing surprises, it’s important to know that preventive care doesn’t include everything you might discuss with your primary care provider (PCP). Most important, be clear that you want preventive care when you schedule your appointment, so your provider includes the appropriate services and bills your health plan correctly. During the visit, remember to ask your PCP whether recommended services are considered preventive.

Depending on your plan, you may have to pay some or all of the costs for:

Lab tests like a complete blood count, Lyme disease, thyroid test or Vitamin D test.
Treatment for a new illness or injuries, or for diagnosed conditions and follow-up tests for abnormal screening test results.
Services related to managing chronic, ongoing health concerns, including changing medication or discussing new treatment plans.
Tests or studies when you’re having symptoms, like diagnostic colonoscopies, which are more detailed than a screening test.

Community Health Options Members who don’t have a PCP can choose one, including a virtual primary care option through Firefly Health for Members 18 and over, in their Member portal. The portal also includes details about specific plan benefits, including coverage for preventive and non-preventive services.

Specific plan benefits vary, so please check your plan’s schedule of benefits for details. Have a question about Community Health Options or your benefits? Call our Maine-based Member Services team at (855) 624-6463 from 8 a.m. to 6 p.m., Monday through Friday.

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The most important part of a health plan won’t be found in the Schedule of Benefits

Earlier this year, a Community Health Options Member gave birth to a premature baby. Thankfully, the newborn received the best possible care at a big city hospital, but Mom and Dad lived two hours away with two more children to care for, putting incredible strain on the whole family, on top of having a new baby with complex medical needs.

Our care managers began looking for a solution to end the family’s four-hour commute. Once the baby was stabilized and doing well, we worked with the family, the hospital and their pediatrician to move the newborn closer to home, transferring his care to the same pediatrician who would hopefully care for him the rest of his long and healthy childhood.