Top performance—at work and at home—means staying on top of your game. Getting regular preventive medical care helps you do that.

Preventive care is 100% covered

Preventive care office visits and tests are covered at 100% when you use network providers, so you don’t have to pay anything out of pocket.

What you need to know

Your medical plan covers an annual preventive care visit at no cost to you when services are delivered by a doctor or other provider in your plan’s network. This is care you get to prevent illness or disease, and it typically includes a comprehensive medical evaluation. Here’s what to expect at that visit:

  • Conversation about your medical, social, and family history
  • Physical examination and review of your body
  • Review of current medications
  • Immunizations, as necessary
  • Age/gender-appropriate screening tests that can help you stay healthy and catch problems before they become serious threats to your health (e.g., blood pressure, cholesterol, and others as determined by risk factors such as age, weight, and others)
  • You won’t be charged a copay or fee for the visit as long as your doctor is a network provider

Questions to ask during your visit

Preventive care visits offer you the opportunity to stay on top of your health and help keep small issues from becoming more serious. To start the conversation with your doctor, you can ask important health questions, such as:

  • What should I do to prevent or delay health problems?
  • Are there any changes I should make to improve my health?
  • Are there any other tests or screenings I should have, based on my age or other risk factors?

Preventive vs. diagnostic care

Preventive care is generally precautionary. Diagnostic tests are given when someone has symptoms of a health problem and the doctor wants to find out why.

For example, if your doctor recommends having a screening colonoscopy based on your age, that’s generally covered as preventive care at no cost to you. However, if your doctor recommends a colonoscopy to investigate symptoms you’re having, that’s diagnostic care, and you’ll pay your share of your medical plan’s cost for that.

Tips for proper billing

  • When you call to schedule an appointment, be sure to specify the visit is for routine, preventive care. And when you leave after your appointment, ask the staff to verify your visit was coded as preventive.
  • Confirm the purpose of any exam or procedure with your doctor before you proceed, so you understand how your medical plan will cover it.

If you believe you’ve been mistakenly billed for services or tests during a preventive care visit, call your provider’s office and request they recode your services as preventive care and submit the claim again.

Where to learn more

On the Anthem website, click on the Care tab, and then select Health & Wellness Center from the drop-down menu. Enter your gender and age to view the guidelines Anthem follows for preventive care, based on national health authorities’ recommendations. You can also download the Anthem preventive care guidelines [PDF].

Kaiser members should review the list of Kaiser preventive services.