Overview
What preventive care is covered by my insurance?
Your health insurance typically covers preventive care services and birth control methods. Learn when to schedule screening tests, such as mammograms and pap tests, to help prevent or detect possible health concerns. You can also review the summary of women’s care services covered by Blue Cross and Blue Shield of Minnesota and Blue Plus plans.
What happens at a woman's preventive care visit?
During a preventive care or well woman visit, the doctor will likely do an exam (including breast and pelvic exams), check your blood pressure, recommend vaccines or flu shots, and identify screening tests based on your age and family history.
Preventive care resources
It’s important to understand what’s medically recommended and what your specific plan covers. Use these resources to research. Find more details in your benefit booklet.
Details
What preventive care services are covered for women?
Blue Cross and Blue Plus plans cover these eligible preventive services for women ages 12-64, with no member cost sharing when obtained at the in-network level*:
- Alcohol and substance misuse counseling
- Anemia screening for pregnant women
- Bacteriuria screening for pregnant women
- Blood pressure screening
- Bone density test to screen for osteoporosis
- BRCA screening/counseling (Note: Eligibility for BRCA screening is subject to the criteria in Blue Cross medical policy: “Genetic Testing for Hereditary Breast and/or Ovarian Cancer Syndrome (BRCA1 and BRCA2 Genes)” (VI‐16))
- Breast cancer preventive medication counseling
- Breastfeeding counseling and the purchase of one manual or electric breast pump
- Cervical cancer screening
- Chlamydia infection screening
- Cholesterol abnormalities screening
- Colorectal cancer screening
- Contraceptive methods and counseling
- Depression screening
- Diabetes screening
- Folic acid supplementation (Note: Folic acid supplements for women ages 12 – 64, when member has a prescription and purchases at the pharmacy or pharmacy counter)
- Gestational diabetes mellitus (GDM) screening (Note: During pregnancy, regardless of presence or absence of high-risk factors. Initial glucose test; if positive, confirmatory glucose tolerance test.)
Is birth control covered by insurance?
Contraceptives are typically covered by insurance, as prescribed, when provided in-network.
The following types of contraceptives may be covered under the preventive contraceptive benefit (subject to change):
- Barrier methods, such as diaphragm, sponge, cervical cap, spermicides and internal condoms
- Hormonal methods, such as birth control pills/oral contraceptives, skin patches, injections or vaginal ring (pharmacy only)
- Intrauterine devices/IUD (medical only)
- Permanent birth control (medical only)
- Emergency contraception (pharmacy only)
Some tests ordered by a provider during a preventive exam may not be covered.
What can I do to stay healthy?
Annual exams and periodic preventive screenings are important for your health and wellbeing. In addition, your day-to-day health habits can have a big impact on your health as you age: managing stress, eating right, staying active, managing weight and quitting smoking.
If you need help finding a primary care or ob/gyn doctor for annual exams, you can log in and search for a provider. You can also access tools and resources to help you stay healthy.
- Gonorrhea screening
- Healthy diet counseling
- Hepatitis B screening: pregnant women
- HIV (human immunodeficiency virus) screening and counseling (Note: Group or individual sessions, 30‐minute maximum per session, one per year)
- Interpersonal and domestic violence counseling
- Mammogram to screen for breast cancer (age 40 and older)
- Nutrition, healthy weight and physical activity consultation
- Obesity screening and counseling
- Osteoporosis screening (age 65 and older)
- Pap test to screen for cervical cancer (starting at age 21)
- Pap test and HPV (human papillomavirus) testing to screen for cervical cancer (starting at age 30)
- Preventive gynecological exam
- Rh (Rhesus) incompatibility screening: first pregnancy visit
- Rh (Rhesus) incompatibility screening: 24 to 28 weeks gestation
- Sexually transmitted disease screening
- STI (sexually transmitted infection) counseling (Note: Group or individual sessions, 60‐minute maximum per session, one per year)
- Syphilis screening
- Tobacco use counseling and interventions (Note: Certain OTC (over‐the‐counter) and prescription tobacco cessation products, when member has a prescription and purchases at the pharmacy or pharmacy counter)
*This information may change from time to time as determined appropriate by Blue Cross and/or Blue Plus. Coverage for specific preventive services may differ from that described in this document. Not all items on this list are covered benefits for all products or groups with Blue Cross or Blue Plus. For the most up-to-date information about benefits that may be available to you, check your health plan benefits or contact customer service at the number on the back of your member ID card. Coverage for certain items and services may only be provided for plan and policy years after a certain date. This list may not represent all possible tests or benefits, and inclusion of a service or item on this list does not guarantee coverage. Additional requirements may apply. Tests ordered during a preventive visit that are not considered preventive care or treatment/tests for an existing condition or illness that are not considered preventive care may be subject to deductibles, copays and/or coinsurance. Out‐of‐network services may incur member liability or may not be covered.
We feature a large network of health care providers. Each provider is an independent contractor and not our agent.
Prime Therapeutics LLC is an independent company providing pharmacy benefit management services.
This information does not apply to members of Medicare and Minnesota Health Care Programs.