Preventive care services at no cost to you
Under both Oregon and federal laws, all health insurance plans, with few exceptions, must provide preventive care services at no cost to members as long as the members get the service from an in-network provider. This means your doctor cannot charge you co-pays, deductibles, or co-insurance when providing preventive care.
Preventive care includes, but is not limited to, the following:
- Flu and pneumonia shots
- Well-woman visits
- Contraception
- Regular well-baby and well-child visits from birth to age 21
- Breastfeeding support, supplies, and counseling, including the cost of renting breastfeeding equipment
- Counseling, screening, and vaccines to ensure healthy pregnancies
- Blood pressure, diabetes, and cholesterol tests
- Many cancer screenings, including mammograms and colonoscopies
- Counseling and treatment to stop smoking
- Counseling for weight loss and healthy eating
- Depression screening
- Counseling to reduce alcohol use or treat problem drinking
- Routine vaccinations for children and adults against diseases such as measles, polio, and meningitis
Understanding your rights to coverage
Recommended preventive care services are based on your age, gender, and other health factors. Only services on the U.S. Preventive Services Taskforce "A" and "B" recommendations lists are covered at no expense to you. Visit the links to the right for full lists of covered preventive health care services.
While in no way a comprehensive list, consumers should know they have a right to the following types of preventive care with no cost sharing.
For children
- Autism screening for children at 18 months and 24 months
- Gonorrhea preventive medication for the eyes of all newborns
- Hearing screening for all newborns
- Lead screening for children at risk of exposure
- Phenylketonuria (PKU) screening for newborns
- Vision screening for all children
- Fluoride treatment for some children
- All recommended vaccines
For more preventive health services for children, visit
https://www.healthcare.gov/preventive-care-children/.
For women
- All types of contraception as recommended by your doctor
- Breast cancer screening and counseling, including mammograms and genetic testing.
- Breastfeeding comprehensive support and counseling from trained providers and access to breastfeeding supplies for anyone pregnant or nursing
- Well-woman visits
- Folic acid supplements for anyone who may become pregnant
- Osteoporosis screening for those older than 60, depending on risk factors
- Gestational diabetes screening for anyone 24 to 28 weeks pregnant and those at high risk of developing gestational diabetes
- All recommended vaccines
For more preventive health services for women, visit
https://www.healthcare.gov/preventive-care-women/.
For adults
- Aspirin use to prevent cardiovascular disease for anyone of certain ages
- Colorectal cancer screening for anyone older than 50, including fecal occult blood testing, colonoscopies, and any necessary anesthesia or biopsies
- Sexually transmitted disease testing
- Type 2 Diabetes screening for those with high blood pressure
- All recommended vaccines
For more preventive health services for adults, visit
https://www.healthcare.gov/preventive-care-adults/.
You can also use the myhealthfinder tool to see which preventive care services are recommended for you based on your age and gender. Talk to your doctor or nurse about which recommendations are right for you.
Common billing issues
- Preventive services are covered with no cost to you only when you use in-network providers. For example, if a colonoscopy is performed, the clinic, physician, anesthesiologist, and lab must all be in-network providers. Always confirm before any procedure that all providers involved are in-network. If you do not, you may see significant out-of-network charges that your insurance company will not cover.
- You may be billed for a visit if other non-preventive care services are provided. For example, asking your provider about a sore throat during a wellness visit may be billed separately from your wellness visit. That means your visit may not be completely covered at no cost to you.
- Health care services traditionally considered preventive, such as mammograms or labs, will not be billed as preventive services if they are performed as diagnostic or follow-up services. For example, mammograms performed as a follow-up to a previous or current health condition will not be covered.