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

Jul 16, 2024

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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 or colorectal cancer screenings.
Talk about changes you can make to maintain your health if you’re at risk for certain conditions, given your medical history or other findings.
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.

If you have questions about your plan and what’s covered, or need help finding a PCP, please call Member Services at (855) 624-6463 from 8 a.m. to 6 p.m. Monday through Friday.

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We are steadfast in our support for the well-being of our fellow Mainers and will do everything within our ability to facilitate easy access to care—including behavioral and mental health services.