Preventive Care

Stay healthy—annual checkups, vaccinations, and screenings. Be proactive about your health to catch potential health issues while they’re easier to treat. In-network preventive services are 100% covered (free to you) by your LifeWise plan.

Getting care

Use Find a Doctor to locate a doctor in your network. As long as you stay in network, you don’t need referrals for specialty care. On most plans (except the Catastrophic plan), you get unlimited visits though copay, deductible, or coinsurance apply.

Routine exams can help spot health issues early, before they become more serious and harder to treat. That's why LifeWise offers routine preventive medical exams at no cost, as part of your plan benefits. Checkups are also a great time to ensure you're up to date on vaccinations and boosters.

3 ways to stay well & prevent illness

1

Find an in-network primary care physician. Use the Find Care tool on Lifewise.com. In-network doctors will reduce your out-of-pocket costs.

2

Schedule a preventive exam, at no cost. You’re covered for one exam per year. Your doctor may recommend routine cancer screens like mammograms and colonoscopies. It’s best to have preventive visits about 12 months apart.

3

When signed in, get all your preventive benefit details—learn what’s 100% covered with preventive care.

Learn more about preventive services 

Benefits highlights for preventive care

Checkups

Annual wellness exams are free in-network. But if you discuss a symptom, injury, or condition, you may be charged for a regular office visit (not free).

Routine bloodwork at an annual checkup is free. Other lab work and biopsies are usually covered, but not free.

Vaccinations

COVID-19 vaccines are free. Flu shots are free at any pharmacy or at in-network doctors’ offices. All other routine vaccines are free at in-network doctors' offices. Travel vaccines (like typhoid) are free at travel clinics or county health departments.

Screenings

Routine screenings for cancer (like mammograms and colonoscopies) are free in-network. Skin cancer screenings by a dermatologist are covered, but not free. If your test is ordered because of a symptom or concern, it is diagnostic. It may be covered but is not free.

Screening or diagnostic?

The same test—like a colonoscopy—can be either a screening (free) or diagnostic (covered, but not free). How can you tell? If the test is used to check out a sign, symptom, or health concern, it is diagnostic. Avoid surprise costs: Ask your doctor if a recommended test is preventive. If they say "no," then it's not free.

Virtual care 24/7

Connect day or night with doctors (covered as in-network) for issues like cold and flu, allergies, ear infections, and skin rashes using virtual care apps. You can get labs and drugs prescribed. Virtual care apps (such as DoctorOn Demand) are not free but can be cheaper than urgent care.

Browse virtual care options

Help with healthcare decisions

Ultimately, it’s up to you to decide what medical care to have. Healthwise is an independent, nonprofit that offers guides and tools in clear language and give you the same science-backed information your doctor has. You can understand your options and discuss with your doctor what care is best.

Find health condition resources

Diabetes whole-body care

Diabetes can impact your whole body, so we cover the following in-network: preventive care annual exams (free), dietician visits (free), and certified diabetes classes (free).

Screenings

An ounce of prevention—Screenings are important to detect issues before they become big and difficult to treat. Your health plan is designed to help you get the care you need. Read on for some common adult screenings.

Is it preventive or diagnostic?

After you've been diagnosed with a medical condition, tests to monitor that condition are no longer considered preventive, and will be billed as diagnostic. Your doctor might also order tests that are not covered as preventive. That means services are subject to cost shares like copays and coinsurance.

Mammograms

We cover mammograms for men and women, subject to the terms of specific plans, based on what you and your healthcare provider decide is best for you, including your risks and preferences. Computer-aided and 3Dmammography are also covered. If done as a diagnostic test rather than preventive screening, it may be subject to cost shares.

STD testing

Preventive screenings vary for men and women. Your health plan covers preventive care services as required by state and federal law. For more information, review the "A" and "B" rated services on the United States Preventive Task Force, vaccinations recommended by the Centers for Disease Control and Prevention, and preventive care and screening recommended by the Health Resources and Services Administration. See the list on healthcare.gov.

Colonoscopies

Colonoscopies are tests used to detect colon cancer and are covered as part of preventive checkups from age 45-75. Your plan covers repeat screenings every 5 years. While colonoscopies certainly aren't pleasant, they can be life-saving. If you have a strong family history of colon cancer, you may be covered for colonoscopy at an earlier age.

A colonoscopy examines the entire colon. The test includes a consultation prior to your screening and preparation, and gentle sedation is often used (although some people may need anesthesia). Your initial screening colonoscopy is covered in full on many plans, even if polyps are found (whether benign or cancerous). Follow-up colonoscopies for those who have had a cancerous polyp are not considered screening and are subject to a copay and your deductible.

Note: This procedure can cost more than $2,000. Be sure you know the date of your last screening before you schedule your 5-year follow-up. Your online claims are accessible via your secure LifeWise account for only 3 years. If you're unsure when your last screening was done, contact your doctor’s office. To check your coverage, contact us.

Anesthesia
Full anesthesia isn't always covered as part of your colonoscopy. Your doctor will determine what level of anesthesia is right for you to ensure you're as comfortable as possible.

A request for "extra" or full anesthesia won't necessarily be covered, and you'll be responsible for this expense.

Preparing for your test
Colonoscopies include over-the-counter, pre-colonoscopy laxatives, also called cleansing preparations. Your plan coverage is limited to 2 preparations every 365 days, and they require a written prescription from your doctor.

Colon cancer screening at-home test

At-home screening options have made colon cancer screenings much simpler. However, they're not appropriate for everyone. Talk to your doctor. Depending on your family history and risk factors, they might recommend one over another.

A fecal occult blood test (FIT) test is simple. These tests can be an alternative to a colonoscopy, assuming you don't have other risk factors. They're done at home without special preparation, in the comfort of your own bathroom. There are two types of test kits on the market for at-home colon cancer screening are Cologuard (DNA FIT) and standard FIT kits.

Are there accurate and cost-effective at-home colon cancer screening tests?
Yes. FIT and FOBT tests are accurate and cost-effective at-home screening options. The fecal occult blood test (FOBT) and fecal immunochemical test (FIT) are both recommended by the U.S. Preventive Services Task Force for at-home colon cancer screenings. Although these tests are recommended annually, the total cost of annual FIT/FOBT tests remains less expensive (about $30.00 which is typically fully covered for members when prescribed as part of a preventive screening) than a single Cologuard test every 3 years. We encourage you to discuss this option with your provider.

Is  Cologuard more accurate than a traditional FIT kit?
No. Cologuard includes a patented DNA test unique on the market. However, Cologuard often results in false positives for abnormal DNA markers that aren’t explained by subsequent colonoscopy findings. False positives that aren’t explained by colonoscopy findings may generate unnecessary ongoing surveillance or anxiety for patients. The Cologuard test is also a more expensive test because of the DNA testing. LifeWise pays for a large cost share of the Cologuard test, however Exact Sciences Laboratories, the only company that offers the Cologuard test, balance bills members about $200, depending on the your health plan.

Compare procedure costs

You can also use our personalized Find Care tool to compare costs for healthcare procedures including colonoscopies. Go to your LifeWise account and select Find Care.

Sign in to compare costs in Find Care 

"Free" means no out-of-pocket cost to you. "Covered" means included on your health plan, but with cost shares you pay (like deductibles, copays, coinsurance).

Benefits under your health plan may differ, so refer to your benefit booklet for information on what your specific health plan covers. Your health plan covers preventive care services as required by state and federal law. For more information, please review the "A" and "B" rated services on the United States Preventive Services Task Force, immunizations recommended by the Centers for Disease Control and Prevention and preventive care and screening recommended by the Health Resources and Services Administration. See the list on healthcare.gov.