Doctors HealthCare Plans wants you to get the preventive care you need!
Your Evidence of Coverage include details on the preventive care covered by your plan however here’s a summary of the preventive tests, screenings, vaccinations and exams that are covered at no cost to you.
Preventive vs. diagnostic tests
Remember, the services listed here are only preventive when you have no symptoms – if your doctor orders a test or screening because you are having symptoms, the test is considered “diagnostic.” That means you may have to pay a cost share- please refer to your Evidence of Coverage for more information.
Get your annual wellness visit
Doctors HealthCare provides every Medicare Advantage plan member with an annual wellness visit, and there’s no cost to you.
Abdominal aortic aneurysm (AAA) screening
Who is covered: Those with certain risk factors for AAA, specifically for men aged 65-75 who have ever smoked.
When: Once in a lifetime, with a referral from your doctor.
Alcohol misuse -screening and counseling
Who is covered: All members
When: Annually
If you screen positive for alcohol misuse, you can get up to four in-person counseling visits per year (you must be competent and alert during counseling).
Bone mass measurement
Who is covered: Members who are at risk of losing bone mass or at risk of osteoporosis.
When: Once every 24 months, or more frequently if medically necessary.
Breast Cancer Screening (Breast Exams and Mammograms) (more information)
Who is covered: All female members
When: Breast exams: monthly; Breast Cancer screening: every 12 months for women aged 50-74 years. Baseline mammogram between ages of 35-39.
Cardiovascular disease risk reduction visit
Who is covered: All members
When: Annually
Cardiovascular disease testing
Who is covered: All members
When: Once every 5 years, when ordered by a doctor
Cervical (Pap test) and vaginal (pelvic) cancer screening (more info)
Who is covered: All female members
When: Pap test: every 24 months until age 70. Pelvic screenings: Every 24 months
Pap test annually if at high risk of cervical cancer or if you’ve had an abnormal Pap test within the past 3 years and are of childbearing age.
Colorectal cancer screening
Who is covered: All members age 50 and older.
When: Consult with your physician on the screening you need: Guaiac-based fecal occult blood test (gFOBT), fecal immunochemical test (FIT), DNA based colorectal screening, flexible sigmoidoscopy, colonoscopy, barium enema, Cologuard
- Flexible sigmoidoscopy (or screening barium enema as an alternative) every 48 months
- One of the following every 12 months:
- Guaiac-based fecal occult blood test (gFOBT)
- Fecal immunochemical test (FIT)
DNA based colorectal screening every 3 years
For people at high risk of colorectal cancer: Screening colonoscopy (or screening barium enema as an alternative) every 24 months
For people not at high risk of colorectal cancer, we cover: Screening colonoscopy every 10 years (120 months), but not within 48 months of a screening sigmoidoscopy
Depression screening
Who is covered: All members
When: Annually.
Diabetes screening
Who is covered: Members at risk
When: Up to 2 tests per year
Diabetes self-management training (DSMT)
Who is covered: Members with diabetes
When: As prescribed by your doctor
Glaucoma screening
Who is covered: Medicare members with diabetes or a family history of glaucoma, African-Americans age 50 or older, and Hispanic-Americans age 65 or older
When: Annually
Health and Wellness Education Programs
Who is covered: Members at risk for specific disease
When: As prescribed by your doctor
Hepatitis C (HCV) screening (more info)
Who is covered: Members at high risk due to: Current or past history of illicit drug use, or blood transfusions prior to 1992, for adults aged 18-79 years.
When: Once per lifetime, or annually for certain people at risk
HIV screening
Who is covered: All members who ask for HIV screening test or who are at increased risk for HIV infection
When: Annually or up to 3 times during a pregnancy
Immunizations
Who is covered: All member; Members at medium- to high-risk for Hepatitis B
When:
Hepatitis B: Check with your doctor
Influenza (flu): Annually
Pneumococcal (pneumonia): Check with your doctor
Covid-19: Vaccine and or booster (more information)
Other vaccines if you are at risk and they meet Medicare Part B coverage rules. We also cover vaccines under our Part D prescription drug benefit. Please review Evidence of Coverage for details
Lung cancer screening with low dose computed tomography (LDCT)
(more info)
Who is covered: Members who meet all of these criteria:
- Age 50-77
- Asymptomatic (no signs or symptoms of lung cancer)
- Current smoker/quit smoking in the last 15 years
- Tobacco smoking history of at least 20 pack-years (one pack-year = smoking one pack per day for one year; 1 pack = 20 cigarettes)
When: Annually, when ordered by your doctor
Medical nutrition therapy
Who is covered: Members diagnosed with diabetes or a renal disease or who have had a kidney transplant
When: As ordered by your physician
Medicare Diabetes Prevention Program (MDPP)
Who is covered: Members that could prevent or delay type II diabetes.
When: Once per lifetime
Obesity screening and therapy to promote sustained weight loss
Who is covered: Members with BMI greater than 30
When: Consult with your physician
Prostate cancer screening
Who is covered: All male members age 50 or older
When: Annually for a digital rectal exam and prostate specific antigen (PSA) test.
Vision care
Who is covered: All members
When: Annually routine eye exam.
Sexually transmitted infections (STIs), screening and counseling (more information)
Who is covered: Members at increased risk for STIs, or pregnant women
When: Every 12 months, or at certain times during pregnancy
Smoking and tobacco use cessation (quit) counseling(more information1) (more information 2)
Who is covered: All members
When: 2 counseling quit attempts within a 12-month period. Each counseling attempt include up to four face-to-face visits
Welcome to Medicare preventive visit
Who is covered: All members
When: Within the first 12 months you have Medicare Part B
H4140_MMPREV_C
Last Updated: 02/17/2022
