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Preventive Care

Preventive care for men

Find out which health services for men are covered at 100%.

Cancer screenings and counseling

Disease prevention and heart health

Sexual health

Mental health and substance abuse

Nutrition and wellness

Immunizations

Medications
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List of what's covered

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

Cancer screenings and counseling

Who should get it: Age 45 to 75*

  • Description: Screening for colon/colorectal cancer in adults age 45 to 75. *Effective no later than April 1, 2022, colorectal cancer screening and associated services are covered at 100% for eligible members aged 45 and older.
  • Frequency: Using fecal blood testing (gFOBT or FIT) annually, Cologuard every 3 years, 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), or visualization test (CT colonography or sigmoidoscopy), your doctor may order a follow up colonoscopy. Starting June 1, 2022, this follow up colonoscopy will be covered at 100%.
    • 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%.
    • Provider consultation prior to the colonoscopy procedure 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 (PDF); if you meet these criteria, they can submit this information on the ACA Copay Waiver form (PDF).
    • Barium enema is a covered service but not at 100% so you may have out of pocket costs.

Who should get it: Age 50 to 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

Who should get it: Age 10 to 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

Who should get it: Men age 65 to 75 if you have ever smoked

  • Description: Screening by ultrasonography
  • Frequency: Once

Who should get it: Adults aged 35 to 70 who are overweight or obese

  • Description: Screening for prediabetes and type 2 diabetes for adults aged 35 to 70 who have overweight or obesity. Clinicians should offer or refer patients with prediabetes to effective preventive interventions.
  • Frequency: May vary based on your health so ask your doctor

Who should get it: Age 18 or older

  • Description: Screening for high blood pressure, or hypertension, in adults with office blood pressure measurement. 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 Care tool.

Who should get it: Age 18 or 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.

Who should get it: Adults aged 40 to 75 with certain risk factors

  • Description: Statins for the primary prevention of CVD in adults aged 40 to 75 years who have 1 or more CVD risk factors (dyslipidemia, diabetes, hypertension, or smoking) and an estimated 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 (PDF); if you meet these criteria, they can submit this information on the ACA Copay Waiver form (PDF). 
    • Screening for high cholesterol is also covered at 100% every 5 years or annually for those with increased risk for CVD.

Sexual health

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

Who should get it: Men aged 18 to 79

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

Who should get it: Persons at high risk of acquiring HIV

  • Description: Offer pre-exposure 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) and Apretude (under medical benefit)
    •  If either of these two scenarios apply to you, have your provider fill out and fax the ACA Copay Wavier form (PDF).  
      1. Scenario 1: Brand Truvada, Viread, or Descovy may be made available if you are clinically unable to use generic Truvada.
      2. Scenario 2: Your claim for emtricitabine/tenofovir (generic Truvada) or Apretude is not paying at 100% and you are using it for PrEP.
  • Frequency: May vary based on your health so ask your doctor

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

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

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 use

Who should get it: Age 18 or 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

Who should get it: Age 18 or 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

Who should get it: Age 18 or 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

Who should get it: Age 18 or older

  • Description: Ask all adults about tobacco use, advise them to stop using tobacco, and provide behavioral interventions and US 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 (844-862-7848).
    • FDA-approved tobacco cessation prescription medications (PDF) 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

Who should get it: Age 65 or 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

Who should get it: Adults with cardiovascular risk factors

  • Description: Offer or refer adults with cardiovascular disease (CVD) risk factors to behavioral counseling interventions to promote a healthy diet and physical activity.
  • Frequency: May vary based on your health so ask your doctor
  • More information: Preventive care includes 4 treatments provided by a physician and 30 nutritional counseling visits by a licensed dietitians or nutritionist

Who should get it: Age 18 or 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 30 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.

  • COVID-19
  • Haemophilus influenza type b
  • Herpes Zoster (Shingles)
  • Hepatitis A
  • Hepatitis B
  • Human papillomavirus (HPV)
  • Influenza (Flu)
  • Measles, mumps, rubella (MMR)
  • Meningococcal
  • Pneumonia
  • RSV (Respiratory Syncytial Virus)
  • Tetanus-Diphtheria/Tetanus-Diphtheria Acellular Pertussis (Tdap)
  • Varicella (Chicken Pox)

Medications

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.

Remember, 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)