Preventive Services for Women Over Age 55

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Ladies, did you just hit that sweet age of 55 (or know someone who has)? In addition to senior discounts (looking at you cheap movie tickets), being 55 or older means you get more healthcare screenings that are 100% FREE! We’ve outlined some of the major ones below:

While these services are free if you stay in-network and meet the criteria (usually age) for coverage, it is easy for the coding on these services to change if you go off topic during your visit. Learn more about preventive (screening) vs diagnostic coding and check out this chart by the US Preventive Services Task Force.

Annual Physical

Annual physical are free and important throughout life, but at 55+ they are critical in maintaining health in your golden years.  During your annual physical your doctor will typically:

  •  Talk to you about your lifestyle and health history

  •  Measure your height, weight, blood pressure, and temperature

  •  Conduct a full body exam

  •  Take a blood sample to run lab tests

Note: The tests that doctors run during an annual physical vary, however, you can always ask what your doctor usually test for when you make the appointment. Once you find out, compare those tests with your insurance company’s list of preventive services before visiting the doctor. Read this article on lab billing to learn more.

Your doctor should also use this time to recommend other preventive (and possibly diagnostic) services that you should receive based on your age, including mammograms and colonoscopies.

Mammograms

While exact coverage varies by payor, by age 55, all women qualify for at least a biennial mammogram screening until the age of 75. Check out this list to understand the specific guidelines.

  •  Your primary care doctor can make the referral to an imaging center for a mammogram.

  • While preventive mammograms are covered at 100% at in-network imaging centers, if you have a history of breast cancer or have had a recent mammogram come back with suspicious results, your latest mammogram order will usually have a diagnostic code attached to it, meaning it is not covered at 100%.

  • Some imaging facilities will do a 3D mammogram if you have dense breast tissue. This is not always covered as preventive under most insurance plans.

If you aren’t sure how your exam is going to be billed, ask your doctor for all of the details of the order (CPT and Diagnosis Codes) before you go for the exam.

Bone Density Scans (DEXA)

Bone Density Scans (also known as DEXA scans) are important in detecting osteoporosis. According to the US Preventive Services Task Force, osteoporosis screenings are recommended for women 65 and older. Just like your mammogram, your doctor can make the referral for a DEXA scan during your annual physical. Make sure you check your insurance company’s preventive guidelines before scheduling the DEXA appointment!

Colonoscopy

Don’t worry, we didn’t forget about everyone’s favorite test, the colonoscopy! The US Preventive Services Task Force recommends preventive colorectal screenings for adults age 50 to 75. Similar to your mammogram, while preventive colonoscopies are covered at 100% at in-network facilities, if you have a history of colon cancer or have had a recent biopsy from a colonoscopy come back with suspicious results, your latest colonoscopy order will usually have a diagnostic code attached to it, meaning it is not covered at 100%. If you aren’t sure how yours is going to be billed, ask your doctor for all of the details of the order (CPT and Diagnosis Codes) before you schedule the procedure.

Flu Shot

Annual flu shots are covered at 100% as long as you get it from an in-network provider. Usually your primary care doctor can give the flu shot, but some insurance plans are finicky about who needs to provide the immunization. Before getting your flu shot, call your insurance company to find out their specific requirements first. A few of the major payors provide their advice below:

Preventive Care Services By Insurance Company

As mentioned above, coverage varies based on the insurance company. Below are links to the preventive services page for some of the largest insurance companies in the country, along with the Healthcare.gov guidelines.