How to Know Which Preventive Services Are Covered
Learn more about preventive care services and how to find out what's covered by your health plan.
When you’re sick or injured, Blue Cross VT is here to provide support for you to get better. We also want to help you stay healthy, so our health plans provide coverage for preventive care services, such as screenings and vaccinations.
How can you find out which preventive care services are covered by your health plan? There are several ways:
- Read our preventive care guide. On our website you’ll find a guide to all the preventive care services that we cover at $0 cost to you. The guide is divided into three categories: children and adolescents from birth to age 17; adults age 18 and older; and pre-natal care and family planning. The guide identifies the ages at which a preventive care service is covered and includes other important information about the services.
- Check your outline of coverage. Your outline of coverage specifies everything that your health plan covers, including preventive services. You may have received the outline of coverage by mail when you signed up for your health plan. It’s also available through the Member Resource Center (MRC). Check out our blog article on how to use your outline of coverage.
- View Medicare’s preventive services list. If you are enrolled in Medicare, you can use this list of preventive and screening services to determine what Medicare Part B covers.
- See what’s included in qualified health plans. If you are enrolled in a qualified health plan (QHP) under the federal Affordable Care Act, such as those offered through Vermont Health Connect, certain preventive services are required to be included at no additional cost to you. The list of covered preventive services for QHPs is published on the Healthcare.gov website.
Are Preventive Services Free?
All of our health plans cover preventive care services, as defined by federal and state law, at zero cost to members, if they are received from in-network providers. You can use our Find-a-Doctor tool to locate in-network providers.
Examples of preventive care services include:
- Annual wellness visits
- Screenings such as blood pressure, cholesterol, diabetes, breast cancer (mammograms), and colon cancer (colonoscopies)
- Standard immunizations such as flu, tetanus, and measles
However, there may be times when preventive care services are not free, and members have to pay some of the cost. Generally, a service does not qualify for zero-cost preventive care if a medical problem is known, suspected, or found during the course of care.
- Preventive care starts with the intent of confirming that you are healthy and free of symptoms or disease.
- Diagnostic medicine happens when you go to a provider with symptoms and the provider uses screenings or tests to diagnose the cause. Members may have to pay deductibles, copayments, or coinsurance for diagnostic medicine.
Sometimes, preventive care can become diagnostic medicine. For example, a provider begins a screening and then finds or suspects a disease. If that happens, the provider may bill us for a diagnostic procedure. The member may then have to pay some of the cost.
Contact Us If You Have Questions
If you have questions about whether a preventive care service is covered by your health plan, or what the cost may be, please contact our customer service team. You are welcome to contact us before your appointment—we’ll be glad to help! We’re available at (800) 247-2583 (TTY/TDD:711) Monday through Friday from 7:00 a.m. to 6:00 p.m. You can also log in to your MRC account to send us a secure email.
To learn more about preventive care services, check out our blog article on 12 preventive screenings to help you stay healthy.
