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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.

Benefits and coverage

Many preventive care services are covered at 100% – meaning your plan covers them at no extra cost to you. To be covered, the service must be 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 your coverage by logging into your personalized member portal.

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.

See the full list of covered medications (PDF)

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.

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. 
  • Check your Benefit Booklet in Blue Connect for details on other preventive care benefits. 
  • For transgendered individuals, you have access to medically appropriate preventive services.

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