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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.
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)

Who is covered: All female members
When: Breast exams: Every 24 monthsScreening mammograms: One baseline at 35-39 years old, annually 40+

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

Who is covered: All female members
When: Pap test & 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

Who is covered: Members at high risk due to: Current or past history of illicit drug use, or blood transfusions prior to 1992, or born between 1945-1965
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 members
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
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)

Who is covered: Members who meet all of these criteria:

  •  Age 55-77
  •  Asymptomatic and do not have symptoms of lung cancer
  •  Current smoker/quit smoking in the last 15 years
  •  Have a tobacco smoking history of at least 30 “pack years” (average of 1 pack/day for 30 years)

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

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

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

 

 

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Last Updated 01/24/2019

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