Preventive Services

One-time screening for men ages 65 and older who have ever smoked

Screening and counseling

Screening for adults over age 45, or for individuals under 45 with a family history of colon cancer

Screening for adults age 40-75

Screening for asymptomatic adults with sustained high blood pressure

Screening in adults at higher risk of infection

Screening in adults between the ages of 50 and 60, and those at higher risk of infection

Screening for all adults at higher risk

Annual Screening with low-dose computed tomography for adults ages 50-80 who have ever smoked

Such as an annual physical exam, which may include:

• Aspirin use counseling for men and women of certain ages

• Assessment and management to prevent falls in adults 65 and older

• Blood Pressure screening

• Depression screening

• Diet counseling for adults at higher risk for chronic disease

• Counseling for diet and exercise to prevent cardiovascular disease

• Obesity screening and counseling

• Counseling for minimizing risks of skin cancer in adults under age 24

• Counseling for adults at higher risk of Sexually Transmitted Infection (STI)

• Well woman visit to obtain women's preventive services

Screening for adults at higher risk

Screening and interventions for all adults

Recommendations vary for doses, ages, and populations:

• Hepatitis A
• Measles, Mumps, Rubella
• Hepatitis B
• Meningococcal
• Herpes Zoster
• Pneumococcal
• Human Papillomavirus
• Tetanus, Diphtheria, Pertussis
• Influenza
• Varicella

Vaccine information for "Medicare Prime" members:

In a doctor's office:
Medicare Part B covers the following immunizations
• Influenza (the flu)
• Pneumonia
• Hepatitis B (if you are at medium to high risk)
• Immunizations due to exposure to a disease/condition, illness or injury (e.g. tetanus)

In a pharmacy
Medicare Part D covers the following immunizations
• Zoster (shingles)
• Tdap (tetanus, diphtheria, pertussis)
• If you still have a balance due, simply fill out our Member Reimbursement Claim Form, along with an original itemized bill from your provider, and we will cover the remainder of your costs.

Urinary tract or other infection screening in pregnant women

Screening and genetic test counseling for women at higher risk for certain cancers

Screenings every 1 to 2 years for women over 40. 

Please note: 3D mammograms are covered when done in conjunction with a 2D mammogram.

Counseling about risk-reducing medication for women at higher risk

Interventions to support/promote breastfeeding. This includes coverage for manual and electric breast pumps. Hospital-grade and hands-free models are not covered. 

Screening once every rolling 3 years. (3 years + 1 day)

Screening for sexually active women and/or women at higher risk of infection

Approved by the FDA and requiring a prescription

Screening and counseling

For women who may become pregnant

Screening for pregnant women

Screening for all women at higher risk of infection

Screening at first prenatal visit

Testing for all pregnant women regardless of risk status

Testing one time every 5 years for women 30-65

Screening for women 65 and older or women under 65 that meet additional risk criteria

Counseling on use of aspirin by pregnant women at higher risk

Screening and follow-up testing for women at higher risk

Screening for all pregnant women regardless of risk status

Expanded counseling for pregnant women

Annual visit to obtain women’s preventive services

Assessments for adolescents

Screening for children between their 9 month to 30 month doctor visits

Assessments

Screening for sexually-active females

Screening for newborns

Preventive medication for the eyes of all newborns

Screening for all newborns

Screening

Or sickle cell screening for newborns

Screening for adolescents at higher risk for infection

Screening for adolescents at higher risk

Screening for children at risk of exposure

Panel

Such as a well-child visit, which may include:

• Annual Preventive Visit
• Blood Pressure screening
• Depression screening for adolescents at higher risk
• Developmental screening for children under age 3, and surveillance throughout childhood
• Recommendation for fluoride chemoprevention supplements for children without fluoride in their water source
• Height, Weight, and Body Mass Index measurements
• Recommendation for iron supplements for children ages 6 to 12 months at risk for anemia
• Medical History
• Obesity screening and counseling
• Oral Health risk assessment for young children
• Recommendation for vision and hearing screening for children ages 3 to 5 years to detect amblyopia or its risk factors
• Counseling on minimizing risks for skin cancer
• Tobacco use intervention

Prevention counseling and screening for adolescents ages 11 to 21 at higher risk

Testing for children at higher risk of tuberculosis

For children from birth to age 18—recommendations vary for doses, ages, and populations

• Diphtheria, Tetanus, Pertussis
• Influenza
• Measles, Mumps, Rubella
• Hepatitis A
• Meningococcal
• Hepatitis B
• Pneumococcal
• Human Papillomavirus
• Rotavirus
• Inactivated Poliovirus
• Varicella
• Haemophilus Influenzae Type b