Preventive Care and Health Maintenance: Live healthy.
How to avoid “surprises” and “gotchas” when using your benefits.
Pay a copay at the time of your visit for illness or injury. It’s important to know that many preventive services, like regular checkups, screenings and immunizations, don’t require a copay unless the visit is later linked to a diagnosis or illness.
Find time for routine checkups
Make time this year to take care of YOU. When you see a network provider for preventive services, there’s usually no copay or coinsurance charge. Knowing the difference between “preventive services” and those which are not considered preventive can save you money during an annual checkup.
Preventive Care Fact Sheets
What is covered under your preventive benefit?
Preventive services help keep you from having health problems. Examples are: blood pressure screenings, immunizations, prenatal care, or a routine checkup (physical) when you are not sick.
Please note: It is very important to receive your preventive care from a provider who is in the Medica network. Call Customer Service at the number listed on the back of your ID card or use our Find a Doctor search tool for help finding a network physician. Most Medica plans do not cover preventive care services provided by providers who are not part of our network.
View the chart below to learn more about the services Medica typically covers under your preventive benefit. For more information, please refer to your coverage document or contact Customer Service at the phone number listed on the back of your ID card to confirm what services your plan pays for under your preventive benefit.
View the benefit coverage chart to learn about what is covered by your benefit plan.
| Preventive Service | Frequency Covered by Benefit Plan |
|---|
Medical Exam, including
- Counseling on healthy lifestyle
- Testicular exam
- Prostate digital rectal exam
- Breast exam
- High blood pressure screening
- BMI
| As recommended by physician |
Vision Screening - Eye exam, including glaucoma screening
| 1 screening per year. |
| Hearing Screening | As recommended by physician |
| Immunizations | As recommended by Centers for Disease Control. |
| Osteoporosis Screening (Bone Density Test) | 1 per year |
Laboratory Services, including
- Cholesterol/lipid profile (for those without a diagnosis of high cholesterol)
- Thyroid screening
- Diabetes screening
- Hemoglobin
- Urinalysis
| As recommended by physician |
| Sexually Transmitted Disease Screening | As recommended by physician |
Colon Cancer Screening
- Stool test
- Barium enema
- Sigmoidoscopy
- Colonoscopy
| As recommended by physician |
| Cervical Cancer Screening (Pap Smear) | 1 per year |
| Breast Cancer Screening (Mammogram) | 1 per year |
| Prostate Cancer Screening (PSA -- Prostate Specific Antigen) | 1 per year |
What isn't covered under your preventive benefit?
- A service is not considered preventive if the doctor diagnoses or treats a problem or symptom you already have. Examples are: earwax removal (this is a surgical procedure); treatment of earache, sore throat or other symptoms; or X-rays to diagnose a cough or broken bones.
- To make sure each service you will be receiving is considered preventive, call Medica Customer Service and ask, or check your coverage document.
- Remember: If you receive both types of care at your annual checkup, you will likely incur a copayment for any services that are not considered preventive.
View the out-of-pocket comparison chart.
| Type of Plan | What happens if you receive non-preventive care at your regularly scheduled preventive visit? |
|---|
| Copay plan — You have a copay plan if you pay a set amount, typically $15-45, for an office visit | You are charged a copay for this part of the visit. If your plan also includes a deductible, which means a set amount that you must pay before insurance benefits begin, you will be required to pay for all or some of the visit until the deductible is met.
Most plans do not charge a copay and waive the deductible when the services provided are strictly preventive. |
| Coinsurance plan — You have a coinsurance plan if you pay a certain percentage, typically 20%, for an office visit | You are charged a coinsurance for this part of the visit. If your plan also includes a deductible, which means a set amount that you must pay before insurance benefits begin, you will be required to pay for all or some of the visit until the deductible is met.
Most plans do not charge a coinsurance and waive the deductible when the services provided are strictly preventive. |
View Preventive Care Frequently Asked Questions.
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