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Preventive care

Preventive care is routine health care that helps prevent health problems. Think flu shots, cancer screenings, and blood pressure checks.

Preventive care services for members

For men

See covered services for men based on health history and age.

For women

See covered services for women based on health history and age.

For children

See covered services and vaccinations for infants, kids, and teens.

How can I get preventive care?

Many preventive care services are covered at 100% – meaning your plan covers them at no extra cost to you. To be covered, the medical or dental service you receive must be given at an in-network doctor or facility, filed by your doctor as preventive care, and identified as preventive care under the Affordable Care Act (ACA). See what's covered for you by logging in to your Blue Connect℠ member portal.

Log In to Blue Connect

Avoid extra health care costs

Preventive care is routine health care that includes screenings, checkups, and patient counseling to help prevent illnesses, disease, and other health problems. To avoid extra costs, it's important to know what qualifies as preventive care and what questions to ask your doctor. 

Certain services will be paid at 100%

These benefits, identified by the ACA as preventive care, 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 the Summary of Benefits section of your Blue Cross NC Benefit Booklet contains "Preventive Care" covered under federal law, then you have these benefits at no charge, when they are performed  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. 

 

 

Common preventive care services not 100% covered

These may cost you money at your doctor’s office or lab:

  • Chest X-rays 
  • Thyroid tests
  • EKGs (electrocardiograms) 
  • Urine tests
  • Hormone tests 
  • Vitamin D tests

Questions to ask when you schedule your appointment

  • Tell the person who answers your call: "I want preventive care screenings and tests that are 100% covered by my plan."
  • Ask the person who is scheduling your appointment: "Is my doctor in my plan’s network?"

Questions to ask the doctor during your appointment

  • Will any additional tests or treatments I get during my appointment not be considered preventive care?
  • Will talking about other topics that are not considered preventive care during my appointment lead to out-of-pocket costs? 
  • Can any routine lab work be sent to a Blue Cross and Blue Shield of North Carolina (Blue Cross NC) in-network lab to lower my out-of-pocket costs?

Looking for covered medications?

Under the Affordable Care Act, some medications are covered at 100% on all prescription drug lists or formularies.

These medications include aspirin, certain supplements, tobacco cessation support, and some contraceptives.

For drug and dosage details, refer to the Affordable Care Act (ACA) Preventive Drug List (PDF).

Limitations and exclusions

The Affordable Care Act (ACA) has identified certain services as preventive care services paid at 100%. This information is a reference tool and does not guarantee payment of any claims. 

  • These benefits are available for members of non-grandfathered individual health insurance plans. These benefits may not apply to grandfathered members.
  • If you get benefits from your employer, you may also have these benefits. If the Summary of Benefits section of your Benefit Booklet contains preventive care covered under federal law, then you have these benefits at no charge when you use an in-network provider. 
  • These benefits are currently in effect unless otherwise noted. 
  • Log in to Blue Connect, your member portal, to check your Benefits Booklet for details on other preventive care benefits. 
  • For transgendered individuals, you have access to medically appropriate preventive services.

Frequently asked questions

Sometimes you go to the doctor for preventive care and end up with a charge on your bill. You can avoid surprising costs by following these steps:

  • When you schedule an appointment, ask for preventive care screenings and tests that are 100% covered by your plan.
  • Ask if any tests or treatments done during your appointment are not considered preventive care.
  • Ask if talking about other health problems that are not considered preventive care during your appointment will lead to extra costs.
  • Ask if lab work can be sent to a Blue Cross NC in-network lab.

Preventive services are services you get when you are symptom-free and have no reason to think you are sick. These services may include immunizations, routine cholesterol checks, pap tests and blood pressure screenings. They are covered at no extra cost.

Diagnostic services, on the other hand, are services you get when you have symptoms of an illness or risk factors that might indicate a health problem. These services may include chest X-rays, thyroid tests, EKGs, urine tests and iron level testing. You may be responsible for some out-of-pocket costs.