Stay on top of your health
Use your preventive care benefits
Sponsored content by Anthem
Regular preventive care can help you stay healthy and catch problems early, when they are easier to treat. Our health plans offer all the preventive care services and immunizations below at no cost to you.1 As long as you use a doctor, pharmacy, or lab in your plan’s network, you won’t have to pay anything. If you go to doctors or facilities that are not in your plan, you may have to pay out of pocket.
If you are not sure which exams, tests, or shots make sense for you, talk to your doctor.
Preventive care vs. diagnostic care
What’s the difference? Preventive care helps protect you from getting sick. If your doctor recommends you receive services even though you have no symptoms, that’s preventive care. Diagnostic care is when you have symptoms, and your doctor recommends services to determine what’s causing those symptoms.
Adult preventive care
General preventive physical exams, screenings, and tests (all adults):
• Alcohol misuse: related screening and behavioral counseling
• Aortic aneurysm screening (for men who have smoked)
• Behavioral counseling to promote a healthy diet
• Blood pressure
• Bone density test to screen for osteoporosis
• Cholesterol and lipid (fat) levels screening
• Colorectal cancer screenings, including fecal occult blood test, barium enema, flexible sigmoidoscopy, screening colonoscopy and related prep kit, and computed tomography (CT) colonography (as appropriate)2, 3
• Depression screening
• Diabetes screening (type 2)4
• Eye chart test for vision5
• Hepatitis B virus (HBV) screening for people at increased risk of infection
• Hearing screening
• Height, weight, and body mass index (BMI) measurements
• Hepatitis C virus (HCV) screening
• Human immunodeficiency virus (HIV): screening and counseling
• Interpersonal and domestic violence: screening and counseling
• Lung cancer screening for those ages 50 to 80 who have a history of smoking 20 packs or more per year and still smoke, or who have quit within the past 15 years2
• Obesity: related screening and counseling4
• Prostate cancer screenings, including digital rectal exam and prostate-specific antigen (PSA) test
• Sexually transmitted infections: related screening and counseling
• Tobacco use: related screening and behavioral counseling
• Tuberculosis screening
Women’s preventive care:6
• Breast cancer screenings, including exam, mammogram, and genetic testing for BRCA1 and BRCA2 when certain criteria are met7
• Breastfeeding: primary care intervention to promote breastfeeding support, supplies, and counseling8, 9
• Contraceptive (birth control) counseling
• Counseling related to chemoprevention for those at high risk for breast cancer
• Counseling related to genetic testing for those with a family history of ovarian or breast cancer
• Food and Drug Administration (FDA)-approved contraceptive medical services, including sterilization, provided by a doctor
• Human papillomavirus (HPV) screening9
• Interpersonal and domestic violence: screening and counseling
• Pelvic exam and Pap test, including screening for cervical cancer
• Pregnancy screenings, including gestational diabetes, hepatitis B, asymptomatic bacteriuria, Rh incompatibility, syphilis, HIV, and depression9
• Well-woman visits
Immunizations:
• Diphtheria, tetanus, and pertussis (whooping cough)
• Hepatitis A and hepatitis B
• Human papillomavirus (HPV)
• Influenza (flu)
• Measles, mumps, and rubella (MMR)
• Meningococcal (meningitis)
• Monkeypox and/or smallpox (at risk)
• Pneumococcal (pneumonia)
• Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (COVID-19)
• Varicella (chickenpox)
• Zoster (shingles)
Child preventive care
Preventive physical exams, screenings, and tests:
• Behavioral counseling to promote a healthy diet
• Blood pressure screening
• Cervical dysplasia screening
• Cholesterol and lipid (fat) levels screening
• Depression screening
• Development and behavior screening
• Diabetes screening (type 2)
• Hearing screening
• Height, weight, and BMI measurements
• Hemoglobin or hematocrit (blood count) screening
• Lead testing
• Newborn screening
• Obesity: related screening and counseling
• Oral (dental health) assessment, when done as part of a preventive care visit
• Sexually transmitted infections: related screening and counseling
• Skin cancer counseling for those ages 6 months to 24 years with fair skin
• Tobacco use: related screening and behavioral counseling
• Vision screening, when done as part of a preventive care visit5
Immunizations:
• Chickenpox
• Flu
• Haemophilus influenza type B (HIB)
• Hepatitis A and hepatitis B
• Human papillomavirus (HPV)
• Meningitis
• Measles, mumps, and rubella (MMR)
• Pneumonia
• Polio
• Rotavirus
• Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (COVID-19)
• Whooping cough
Coverage for pharmacy items
For 100% coverage of your over-the-counter (OTC) drugs and other pharmacy items listed here, you must:
• Meet certain age requirements and other rules.
• Receive and fill prescriptions from doctors, pharmacies, or other healthcare professionals in your plan’s network.
• Have prescriptions, even for OTC items.
Adult preventive drugs and other pharmacy items (age appropriate):
• Aspirin use (81 mg and 325 mg) for the prevention of cardiovascular disease (CVD), preeclampsia, and colorectal cancer in adults younger than age 70
• Colonoscopy prep kit (generic or OTC only) when prescribed for preventive colon screening for individuals ages 45 to 75
• Generic low-to-moderate dose statins for individuals ages 40 to 75 who have one or more CVD risk factors (dyslipidemia, diabetes, hypertension, or smoking)
• Metformin (850 mg) to prevent or delay progression of diabetes in individuals ages 35 to 70
• Preexposure prophylaxis (PrEP) for the prevention of HIV
• Tobacco cessation products, including all FDA-approved brand- name and generic OTC and prescription products, for individuals ages 18 and older
Child preventive drugs and other pharmacy items (age appropriate):
• Dental fluoride varnish to prevent tooth decay in children ages 5 and younger
• Fluoride supplements for children ages 6 and younger
Women’s preventive drugs and other pharmacy items (age appropriate):6
• Breast cancer risk-reducing medications, such as tamoxifen, raloxifene, and aromatase inhibitors, that follow the U.S. Preventive Services Task Force criteria2
• Contraceptives, including generic prescription drugs, brand name drugs with no generic equivalent, and OTC items like condoms and spermicides9,11
• Folic acid for women ages 55 or younger who are planning to become pregnant
• Low-dose aspirin (81 mg) for pregnant women who have an increased risk of preeclampsia
If you’d like more help understanding your preventive care benefits, call the number on the back of your member ID card. For a complete list of covered preventive drugs under the Affordable Care Act, view the Preventive ACA Drug List flyer, available at anthem.com/pharmacyinformation.
The preventive care services listed above are recommendations of the Affordable Care Act (ACA) and are subject to change. They may not be right for every person. Ask your doctor what’s right for you.
This sheet is not a contract or policy with Anthem Blue Cross and Blue Shield. If there is any difference between this sheet and the group policy, the group policy provisions will rule. Please see your combined Evidence of Coverage and Disclosure Form or Certificate for exclusions and limitations.
1. The range of preventive care services covered at 100% when provided by plan doctors is designed to meet state and federal requirements. The Department of Health and Human Services decided which services to include for full coverage based on U.S. Preventive Services Task Force A and B recommendations, the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC), and certain guidelines for infants, children, adolescents, and women supported by Health Resources and Services Administration (HRSA) guidelines.You may have additional coverage under your insurance policy. To learn more about what your plan covers, see your Certificate of Coverage or call the Member Services number on your ID card.
2. You may be required to receive preapproval for these services.
3. The follow-up colonoscopy after a positive stool-based or direct visualization (such as a CT colonography or flexible sigmoidoscopy) colorectal cancer screening is considered a screening colonoscopy, meaning it is paid at 100% (so you pay no share of the cost) when provided by a doctor in the plan’s network.
4. The Centers for Disease Control and Prevention (CDC)-recognized diabetes prevention programs are available for overweight or obese adults with abnormal blood glucose or who have abnormal CVD risk factors.
5. Some plans cover additional vision services. Please see your contract or Certificate of Coverage for details.
6. Keep in mind, these recommendations are categorized by “men” and “women,” and are driven by biological sex (male and female) rather than gender identity. Meet with your doctor to determine which recommendations best apply to you based on individual factors, such as your sex assigned at birth and current anatomy.
7. Check your medical policy for details.
8. Breast pumps and supplies must be purchased from suppliers or retailers in your plan’s network for 100% coverage. We recommend using plan durable medical equipment (DME) suppliers.
9. This benefit also applies to those younger than age 19.
10. Counseling services for breastfeeding (lactation) can be provided or supported by a doctor or facility in your plan’s network, such as a pediatrician, OB-GYN, or family medicine doctor, and hospitals with no share of the cost (deductible, copay, or coinsurance) for you. Contact the provider to see if such services are available.
11. You may pay a share of the cost for other prescription contraceptives, based on your drug benefits. Your share of the cost may be waived if your doctor decides that using the multisource brand or brand name is medically necessary.
Anthem Blue Cross and Blue Shield is the trade name of: In Colorado: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. Copies of Colorado network access plans are available on request from member services or can be obtained by going to anthem.com/co/networkaccess. In Connecticut: Anthem Health Plans, Inc. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc., dba HMO Nevada. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. HMO plans are administered by Anthem Health Plans of New Hampshire, Inc. and underwritten by Matthew Thornton Health Plan, Inc. In Ohio: Community Insurance Company. In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In Wisconsin: Blue Cross Blue Shield of Wisconsin (BCBSWI), underwrites or administers PPO and indemnity policies and underwrites the out of network benefits in POS policies offered by Compcare Health Services Insurance Corporation (Compcare) or Wisconsin Collaborative Insurance Corporation (WCIC). Compcare underwrites or administers HMO or POS policies; WCIC underwrites or administers Well Priority HMO or POS policies. Independent licensees of the Blue Cross and Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.
