Preventive Care
Services for Men

Find your health benefits and coverage

Covered Preventive Care Services for Men

The cost of many screenings and checkups is covered at 100% with no out of pocket costs for you and those on your plan. Take advantage of preventive care and stop problems before they get serious.

To be covered with no out-of-pocket costs, the service must be:

  • Provided by an in-network doctor or facility (urgent care facility, outpatient clinic or ambulatory surgery center)
  • Filed by your doctor as a preventive care visit
  • Identified as preventive care under the Affordable Care Act (ACA)


100% covered services for men

The age and frequency listed below are general recommendations.
Talk to your doctor to find out which of these you should have based on your health.

Click on a service to see any limits or exclusions.

Cancer Screenings and Counseling

Colorectal Cancer Screenings

Who Should Get it:

Age 50 - 75

  • Description: Screening for colon/colorectal cancer in adults age 50–75
  • Frequency: Using fecal blood testing (gFOBT or FIT) annually, sigmoidoscopy or CT/virtual colonography every 5 years, or colonoscopy every 10 years. These tests are available in network.
  • More information:
    • If you have a positive fecal blood test (gFOBT or FIT or Cologuard), your doctor may order a follow up colonoscopy. This colonoscopy will be covered but may not be considered preventive so you may have out of pocket costs.
    • If you had a polyps removed during a previous preventive screening colonoscopy, future colonoscopies will be covered but may not be considered preventive so you may have out of pocket costs.
    • Your doctor may order a colonoscopy more frequently than every 10 years. This colonoscopy will be covered but may not be considered preventive so you may have out of pocket costs.
    • Anesthesia and pathology from polyps found during a screening colonoscopy is covered at 100%.
    • Certain bowel preparation medications for a screening colonoscopy are covered at 100% when prescribed by a doctor.
    • If there is a medical reason you cannot use a generic bowel preparation medication, your doctor should review this ACA Copay Waiver Criteria; if you meet these criteria, they can submit this information on this fax form.
    • Barium enema is a covered service but not at 100% so you may have out of pocket costs.

Lung Cancer Screenings  

Who Should Get It:

Age 50–80 and high-risk due to smoking or other exposure

  • Description: Annual screening for lung cancer with low-dose Computed Tomography scan in adults ages 50 to 80 years who have a 20-pack-per-year smoking history and currently smoke or have quit within the past 15 years
  • Frequency: Annually if you qualify as high risk
  • More information: Screening should be discontinued once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery

Behavioral Counseling to Prevent Skin Cancer

Who Should Get It:

Age 10–24 with fair skin

  • Description: Counseling young adults, adolescents, children, and parents of young children about minimizing exposure to UV radiation for persons aged 6 months to 24 years with fair skin types to reduce their risk of skin cancer.
  • Frequency: May vary based on your health so ask your doctor 

Disease Prevention and Heart Health

Abdominal Aortic Aneurysm Screening

Who Should Get It:

Men age 65–75 if you have ever smoked

  • Description: Screening by ultrasonagraphy
  • Frequency: Once

Aspirin to Prevent Cardiovascular Disease and Colorectal Cancer in Men

Who Should Get It:

Men age 50–59 under certain conditions

  • Description: Low-dose aspirin use for the primary prevention of cardiovascular disease (CVD) and colorectal cancer (CRC) in adults aged 50 to 59 years who have a 10% or greater 10-year CVD risk, are not at increased risk for bleeding, have a life expectancy of at least 10 years, and are willing to take low-dose aspirin daily for at least 10 years.
  • Frequency: May vary based on your health so ask your doctor
  • Exclusions: Over-the-counter (OTC) aspirin (81mg) is only covered with a prescription

Diabetes Screening

Who Should Get It:

Adults aged 40 to 70 who are overweight or obese

  • Description: Screening for abnormal blood glucose as part of cardiovascular risk assessment. Clinicians should offer or refer patients with abnormal blood glucose to intensive behavioral counseling interventions to promote a healthful diet and physical
  • Frequency: May vary based on your health so ask your doctor

High Blood Pressure Screening

Who Should Get It:

Age 18 and older

  • Description: Screening for high blood pressure in adults. Obtain measurements outside of the clinical setting for diagnostic confirmation before starting treatment.
  • Frequency: May vary based on your health so ask your doctor
  • More information: Effective January 1, 2017, blood pressure monitors will be covered at 100% for members who have an elevated blood pressure during their doctor's visit, but have not been diagnosed with high blood pressure. This will cover ambulatory blood pressure monitors and home blood pressure monitors. Home blood pressure monitors must be purchased from an in-network DME provider. To find a DME provider, use our Find a Doctor tool on BlueConnectNC.com

Latent Tuberculosis Infection Screening

Who Should Get It:

Age 18 and older if at increased risk

  • Description: Screening for latent tuberculosis in populations at increased risk.
  • Frequency: May vary based on your health so talk to your doctor.

Statin Use for the Primary Prevention of Cardiovascular Disease (CVD) in Adults

Who Should Get It:

Adults aged 40-75 with certain risk factors

  • Description: Initiate use of low- to moderate-dose statins in adults aged 40 to 75 years without a history of CVD who have 1 or more CVD risk factors (dyslipidemia, diabetes, hypertension, or smoking) and a calculated 10-year CVD event risk of 10% or greater. Screening for high cholesterol is also covered.
  • More information:
    • Medications covered at 100%: Lovastatin (20 or 40 mg) or Pravastatin (10, 20, 40 or 80 mg). If there is a medical reason you cannot use a generic statin, your doctor should review this ACA Copay Waiver Criteria; if you meet these criteria, they can submit this information on this fax form.
    • Screening for high cholesterol is also covered at 100% every 5 years or annually for those with increased risk for CVD.

Sexual Health

Hepatitis B Screening

Who Should Get It:

Men at high risk of infection

  • Description: Screening for Hepatitis B for those at high risk of infection
  • Frequency: May vary based on your health so ask your doctor

Hepatitis C Screening

Who Should Get It:

Men aged 18-79

  • Description: Screening for Hepatitis C in adults aged 18 to 79.
  • Frequency: May vary based on your health so ask your doctor

HIV Infection Prevention with Pre-exposure Prophylaxis

Who Should Get It:

Persons at high risk of acquiring HIV

  • Description: Offer preexposure prophylaxis (PrEP) with effective antiretroviral therapy to persons who are at high risk of HIV acquisition
  • More Information: Medications covered at 100%: emtricitabine/tenofovir (generic Truvada). For members who are clinically unable to utilize generic Truvada, brand Truvada, Viread, or Descovy may be made available by completing this form and faxing it to the number on the bottom of this document.
  • Frequency: May vary based on your health so ask your doctor
  • Effective: at renewal on or after July 1, 2020

HIV Screening

Who Should Get It:

Men to age 65 or older if at increased risk

  • Description: Screening for Human Immunodeficiency Virus (HIV). Older men who are at increased risk should also be screened
  • Frequency: May vary based on your health so ask your doctor

Behavioral Counseling to Prevent Sexually Transmitted Infections (STIs)

Who Should Get It:

Sexually active men at increased risk

  • Description: Behavioral counseling for sexually active adults at increased risk for sexually transmitted infections (STIs)
  • Frequency: May vary based on your health so ask your doctor

Syphilis Screening

Who Should Get It:

Men at high risk of infection

  • Description: Screening for Syphilis in those at increased risk of infection
  • Frequency: May vary based on your health so ask your doctor

Mental Health and Substance Abuse

Unhealthy Alcohol Use Screening and Counseling

Who Should Get It:

Age 18 and older

  • Description: Screening adults for unhealthy alcohol use and provides persons engaged in risky or hazardous drinking with brief behavioral counseling interventions to reduce unhealthy alcohol use
  • Frequency: May vary based on your health so ask your doctor

Unhealthy Drug Use: Screening

Who Should Get It:

Age 18 and older

  • Description: Ask questions about unhealthy drug use in adults 18 years or older. Screening should be implemented when services for accurate diagnosis, effective treatment, and appropriate care can be offered or referred. (Screening refers to asking questions about unhealthy drug use, not testing biological specimens.)
  • Frequency: May vary based on your health so ask your doctor

Depression Screening

Who Should Get It:

Age 18 and older

  • Description: Screening for depression in the general adult population. Screening should be implemented with adequate systems in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up
  • Frequency: Part of any problem or preventive office visit

Tobacco Use Counseling

Who Should Get It:

Age 18 and older

  • Description: Ask all adults about tobacco use, advise them to stop using tobacco, and provide behavioral interventions and U.S. Food and Drug Administration-approved pharmacotherapy for cessation to adults who use tobacco
  • Frequency: May vary based on your health so ask your doctor
  • More Information:
    • Telephonic counseling available by calling QuitlineNC at 844-8NCQUIT.
    • FDA-approved tobacco cessation prescription medications and OTC nicotine replacement therapy (NRT) covered at 100%.
      • NRT through QuitlineNC is available without a prescription. Members must enroll in the multi-call program to qualify for up to 12 weeks of NRT. Limited to a 90 day supply each for two cessation efforts.
      • NRT through the pharmacy benefit is available only with a prescription.
      • No prescription medication or NRT limit when received via pharmacy benefit

Nutrition and Wellness

Fall Prevention

Who Should Get It:

Age 65 and older

  • Description: Exercise interventions to prevent falls in community-dwelling adults 65 years or older who are at increased risk for falls.
  • Frequency: May vary based on your health so ask your doctor

Healthy Diet Counseling

Who Should Get It:

Overweight/obese adults with cardiovascular risk factors

  • Description: Offer or refer adults who meet criteria to intensive behavioral counseling interventions to promote a healthful diet and physical activity for cardiovascular disease (CVD) prevention
  • Frequency: May vary based on your health so ask your doctor
  • More information: Preventive care includes 4 treatments provided by a physician and unlimited nutritional counseling visits by a licensed dietician or nutritionist

Weight Loss to Prevent Obesity-Related Morbidity and Mortality in Adults

Who Should Get It:

Age 18 and Older

  • Description: If your body mass index (BMI) is 30 or higher, your doctor should refer you to or offer you intensive, multi-component behavioral interventions
  • Frequency: May vary based on your health so ask your doctor
  • More information: Preventive care includes 4 treatments provided by a physician and unlimited nutritional counseling visits by a licensed dietician or nutritionist

Immunizations

The following are the recommended vaccines for men that are covered with no out of pocket cost. Doses, recommended ages and recommended populations vary.

See your doctor and refer to the CDC’s posted schedule of immunizations for more information.

  • Haemophilus influenza type b
  • Herpes Zoster (Shingles)1
  • Hepatitis A
  • Hepatitis B
  • Human papillomavirus (HPV)2
  • Influenza (Flu)
  • Measles, mumps, rubella (MMR)
  • Meningococcal
  • Pneumonia
  • Tetanus-Diphtheria/Tetanus-Diphtheria Acellular Pertussis (Tdap)
  • Varicella (Chicken Pox)

Medications

List of all medications that are covered at 100% on all formularies.


The Affordable Care Act (ACA) has identified certain services as preventive care to be paid at 100%.

 

  • These benefits are available for members of non-grandfathered individual health insurance plans.
  • If you get benefits from your employer, you may also have these benefits. If your Summary of Benefits section of your Benefit Booklet contains PREVENTIVE CARE covered under federal law, then you have these benefits at no charge IN-NETWORK.
  • These benefits are currently in effect unless otherwise noted.
  • Check your Benefit Booklet for details on other preventive care benefits.
  • This information is a reference tool and does not guarantee payment of any claims.
  • For transgendered individuals, you have access to medically appropriate preventive services.

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