You qualify for two preventive exams per plan year with no out-of-pocket charge to you when you use an in-network provider. You can use one of these for a woman's exam, which typically consists of a pap test, breast exam, evaluation of birth control needs, and possibly screening tests. The other could be used for a general physical, where the provider checks your heart, reflexes, and requests screening tests.
Don't worry about scheduling preventive exams 365 days apart. You get two preventive visits per plan year. So if your plan renews in July, you get two visits between July 1 and June 30. You can use them any time you want, but we recommend having your well-woman exams approximately 12 months apart.
Women's Preventive Exam
If you're sexually active or thinking about becoming sexually active, it's time to schedule a gynecological exam, and then every year after that.
At this appointment, expect your healthcare provider to ask some questions that might be sensitive, but they are important in evaluating your health and all conversation is confidential. Your doctor might ask about family history, drug and alcohol use, sexual preferences (including how many partners you've had and if you prefer men, women, or both), and if you feel unsafe at home.
You can also discuss contraception and sexually transmitted disease protection and any other concerns you might have with your doctor.
Common Women's Preventive Tests
Your doctor might perform a pap smear test, which screens for abnormal cell changes that increase the risk of cervical cancer. Current medical guidelines recommend pap smears starting at age 21, and then every 3 years after that, if they continue to be normal. Your health plan covers pap smears as preventive at the frequency ordered by your healthcare provider.
At the same appointment, doctors might test for human papillomavirus (HPV) and chlamydia. Both are covered as preventive benefits. The Center for Disease Control recommends that girls and boys get the HPV vaccine as early as age 9. It is covered as preventive care for males and females ages 9 to 26 under most health plans. The purpose is to help vaccinate against the most common viruses that can cause cervical cancer. Girls should be vaccinated before they're sexually active.
National guidelines recommend beginning osteoporosis screenings at age 65, though you might have a test at a younger age to set a baseline. Talk to your doctor about screenings if you believe you're at risk.
Your physical exam will vary based on your age and risk. Your health plan allows you and your doctor to determine which tests are best for you and which you can skip. Procedures and tests that qualify as preventive care can include:
Infection and disease screening, including chlamydia, gonorrhea, syphilis, urinary tract or other vaginal infections.
Sexually transmitted infections counseling for sexually active women
Contraception coverage for women: Food and Drug Administration approved contraceptive methods, sterilization procedures, and patient education and counseling, not including abortifacient drugs
HIV screening and counseling for sexually active women at higher risk
Breast cancer genetic test counseling (BRCA) for women at higher risk
Breast cancer mammography screenings every 1-2 years over age of 40.
Cervical cancer screening (Pap Smear) women ages 21 to 65 years with cytology (Pap smear) every 3 years.
Cytology with Human Papillomavirus (HPV) DNA test every 5 years for women age 30 to 65 years with history of normal cytology and HPV results.
Osteoporosis (DEXA scan) screening for women over age 65, depending on risk factors
Colorectal cancer screening with colonoscopy starting at age 50 years old.
Tobacco use screening, counseling and interventions
Lung Cancer: Screening -- Adults Ages 55-80 who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years
Alcohol use screening, counseling and interventions
Drug use screening, counseling and interventions
Depression screening and counseling
Domestic and interpersonal violence screening and counseling
Healthy diet and physical activity screening and counseling
Blood pressure screening
Obesity screening and counseling
Type 2 Diabetes screening (fasting blood glucose)
Lipid panel every 5 years if results historically normal
Immunization vaccines for adults - doses, recommended ages, and
recommended populations vary: Hepatitis, Hepatitis B, Herpes, Herpes
Zoster, Human Papillomavirus, Influenza (Flu Shot), Measles, Mumps,
Rubella, Meningococcal, Pneumococcal, Tetanus, Diphtheria, Pertussis,
Aspirin preventive medication: adults aged 50 to 59 years with a ≥10% 10-year cardiovascular risk.
Keep in mind, though, that if your doctor orders follow-up tests or procedures based on signs and symptoms, those are billed as diagnostic rather than preventive and would not qualify as a free preventive exam. Which means you could be charged for additional services.
Your health plan covers preventive care services as required by state and federal law. For more information, please review the "A" and "B" rated services on the United States Preventive Task Force, immunizations recommended by the Centers for Disease Control and Prevention and preventive care and screening recommended by the Health Resources and Services Administration. See the list on healthcare.gov.