If your plan recently renewed, it’s a great time to check out your benefits coverage. With each new plan year, your benefits change slightly, often to stay in line with government regulations and guidelines. This is also a time when you can start preparing for preventive care appointments you might need. After all, the best way to help yourself and your family stay healthy is with preventive care. When combined with healthy eating and exercise, vaccines and early detection are your key to a long and healthy life. That’s why our member plans offer many preventive treatments at no cost to you when you visit a doctor in your network.
Preventive care isn’t just your annual physical exam. It’s non-emergency care that includes periodic screenings (not always annual), diagnostic testing, immunizations, and even some approved medications and counseling. Review your plan benefits to see what services are designated as fully covered preventive care. Or call a Meritain Health® representative at the number on your ID card if you need help identifying these services for your plan. Your plan will also detail what services are covered through telehealth services, which means you won’t have to commute to your doctor’s office.
Plan your routine care visits for the year
The start of the year is a great time to plan and schedule routine medical services. By planning in advance, you can avoid clustering your appointments in the last couple months of the year. If you’ve been keeping up with your annual exams, you may have already scheduled some appointments for this year. If you can’t remember the exact dates, now is a good time to call your doctor and confirm your appointments so you can write them on your 2022 calendar.
Depending on your age, or the age of your dependents, this year could be an ideal time to schedule an age-specific preventive service (such as a colon screening, mammogram, bone density, HPV vaccine etc.). When scheduling your preventive care appointments, remember to:
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- Identify your visit as a preventive care service or routine service to the scheduler to avoid potential confusion.
- Confirm with your doctor before you leave the office that they listed the service as preventive.
- Remind your doctor to indicate any referrals or lab tests (such as blood work, mammogram, colonoscopy, etc.) through an external provider (or ancillary provider) are for preventive purposes. This will ensure these additional services are not billed as diagnostic visits.
Take full advantage of this valuable part of your benefits plan and enjoy living a healthier lifestyle!
Preventive care vs. sick care
By maintaining a good preventive care health routine, you’re not only helping reduce potential ailments and health risks connected with poor health. You’ll also see benefits in your wallet. For most plans, preventive care services are covered with no out-of-pocket (OOP) costs to you. These services typically include annual checkups with your doctor, routine screenings, immunizations, and even certain medications and counseling services. But these services are generally not preventive if you get them as part of a visit to diagnose, monitor or treat an illness, or injury. This is when copays, coinsurance and deductibles may apply.
However, when you wait to go to your doctor until you’re sick, your visit will not be considered routine, meaning you’re responsible for charges until you meet your deductible and OOP limits. Not only that, waiting until you have symptoms could potentially cost you valuable time if you were to be diagnosed with a life-threatening disease, like cancer or heart disease. Catching these symptoms early through routine screenings typically gives doctors more options for treatment with better probabilities for success, compared to waiting for physical symptoms to emerge.
By keeping up with your preventive care appointments and living a healthy style, you’re helping yourself avoid major medical issues later in life. And that helps you maintain some healthy savings, as well.
Preventive screenings offer the health transparency you need
The importance of preventive screenings is fairly well-known. However, that doesn’t mean everyone is getting their screenings as recommended. Several factors might contribute to you skipping or delaying your screenings, which include:
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- Confusion about where to go, or if a doctor’s recommendation is needed before scheduling.
- A misunderstanding that services won’t be covered through your plan or will be too expensive, when really, they may be fully covered.
- The belief you feel fine, so there’s likely nothing wrong with you.
- A fear something is wrong, but you’re not ready emotionally to handle any potentially upsetting news.
All these thoughts are completely understandable, but a simple call can help get you started. If you’re not sure about coverage or where you can go in your area to have a particular preventive screening done, call the customer service number on the back of your Meritain Health ID card to get help from one of our caring representatives. They can help you better understand your benefits. They’ll also find providers, labs and facilities that are in your plan’s network.
If you’re worried about a potential diagnosis, call your doctor and let them know your concerns. They can prepare you for what to expect at your screening and help you with follow-ups. The key purpose of every screening is to catch problems early so you can take important steps to improve your health.
For adults, covered preventive screenings for adults generally include:
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- High blood pressure.
- Cholesterol (for adults of certain ages or at high risk).
- Cancers (certain screenings are subject to age restrictions).
- Human immunodeficiency virus (HIV).
- Hepatitis B and C.
- Tuberculosis (TB) testing.
- Home blood pressure monitor (one monitoring device per member age 18 and over).
There are potentially more, as well, so be sure to review your benefits for plan-specific screenings available to you.
If you have a family history of cancer or have concerns, you can find helpful information through the American Cancer Society by visiting https://www.cancer.org/healthy/find-cancer-early/screening-recommendations-by-age.html.
For more information about preventive care, you can visit the website for the United States Department of Health and Human Services at www.healthfinder.gov/myhealthfinder.
This article is for informational purposes only, and is not meant as medical advice.
