Frequently Asked Questions

What is preventive care?

There are very important medical services recommended for individuals at average health risk. Examples of these services may include cancer screening, immunizations, lab tests and counseling related to healthy lifestyles. Visit the main Preventive and Health Maintenance page to learn more about the recommended services you need, or contact your clinic.

Do I always have to see a physician or other caregiver within my network for preventive care?

Please note that it is very important to receive your preventive care from a physician or other caregiver who participates in our 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 in identifying a network physician. Most Medica plans do not cover preventive care provided by physicians and other providers not participating in our network.

Is it possible to receive both preventive and non-preventive care during a visit?

Yes. Your physician/provider will use every appointment with you to address your immediate health concerns and discuss preventive and health maintenance needs. Please be sure to specify what you want your appointment to include when scheduling the appointment.

What if I receive non-preventive care at a regularly scheduled preventive visit?

This will depend on your type of health care plan.

Copay plan (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.

Coinsurance plan (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.

Note: Most plans do not charge a coinsurance or copay, and waive the deductible when the services provided are strictly preventive.

How does my provider's claim submission to Medica affect my costs?

Following your appointment, your physician submits a claim with codes representing the services he or she provided to you. If significant time is spent discussing a health issue, your physician may code part of your visit as “non-preventive.” This varies by physician.