Preventive care for men
From routine exams to age-based screenings, getting the right care at the right time can help detect issues early and support your long-term health.
Preventive care for men at every stage of life
Staying on track with preventive care allows your doctor to find health issues early, often before symptoms begin. Screenings and checkups help monitor your health, identify risk factors, and support long-term well-being.
What to focus on to stay healthy
Men’s health can change over time. Getting regular checkups, screenings, and preventive visits makes it easier to address potential health issues before they become serious.
Preventive care also gives you a chance to build a relationship with your doctor and understand your personal risk factors.
Getting the recommended preventive care helps you:
- Identify conditions early, when they are easier to treat
- Stay up to date on recommended screenings and vaccines
- Track important health numbers, such as blood pressure, cholesterol, and blood sugar
- Plan for screenings and follow-up care
- Make informed decisions about your health with your doctor
Wellness screenings help track key health numbers
Blood pressure, cholesterol, and diabetes screenings can help identify risks that may not cause symptoms. These routine checks help your doctor monitor your health and recommend next steps.
Colorectal cancer screening becomes more important with age
Colorectal cancer screenings can detect changes early and are typically recommended starting at age 45. Screening can help prevent cancer or detect it early.
Stay on track with prostate cancer screenings
PSA testing can help screen for prostate cancer. APWU Health Plan coverage includes one routine PSA test annually for men age 40 and older. Talk with your doctor about whether you are due for screening based on your age, health, and risk factors.
Certain preventive care items and services, including immunizations, are provided as specified by applicable law, including the Patient Protection and Affordable Care Act (ACA), with no cost-sharing to you. These services may be based on your age and other health factors. Other routine services may be covered under your plan, and some plans may require copayments, coinsurance, or deductibles for these benefits. Always review your benefit plan documents to determine your specific coverage details.
When a preventive visit may include additional costs
A preventive visit can change when you need additional care. This may affect the bill you receive for certain services.
Scenario 1: Bringing up a new concern
During your annual checkup, you mention a new symptom, like chest discomfort, ongoing fatigue, urinary changes, or pain that won’t go away. Your doctor shifts the conversation to understand your concerns and may recommend tests to find the cause.
While the preventive visit is still part of your care, the portion focused on evaluating symptoms is diagnostic. This is a common situation where a visit can include both preventive and diagnostic care.
What’s happening
- Your visit started as a preventive checkup
- During the appointment, you discussed new symptoms
- Your doctor spent time evaluating your concerns
What this means for you
- The clinic may bill part of your visit differently
- Tests or follow-up care may not be considered preventive
- Coverage depends on the services you receive and how they are billed
Consider asking
- “If we talk about this today, will it change how you bill my visit?”
- “Should I schedule a separate visit for this concern?”
Your plan covers preventive services at no cost when they follow preventive care guidelines and you see an in-network provider. Consider asking about billing before you discuss new concerns.
Scenario 2: Receiving follow-up after a PSA screening
You receive a routine PSA test as part of preventive care. After reviewing your results, your doctor may recommend a repeat test, additional lab work, or a referral to take a closer look. While your initial screening may be preventive, follow-up testing focuses on evaluating a result and may be considered diagnostic care.
What’s happening
- Your original PSA screening was preventive
- Your doctor recommended follow-up based on the result
- The goal of additional testing is to evaluate a concern
What this means for you
- The clinic may bill follow-up testing differently
- These services may not be considered routine preventive screening
- Coverage depends on the services you receive and how they are billed
Consider asking
- “Is this follow-up considered diagnostic?”
- “What should I expect for next steps or costs?”
While your initial screening may be covered at no cost when it follows preventive care guidelines, follow-up testing evaluates a result and may generate a bill. Before your appointment, consider asking how the clinic will bill follow-up testing.
Scenario 3: Getting additional tests during a checkup
During your annual checkup, your doctor recommends additional lab work to take a closer look at an issue. Even though everything happens in one appointment, some tests are preventive, while others that evaluate a concern are diagnostic.
What’s happening
- Your visit included routine preventive screenings
- Your doctor recommended additional tests during the appointment
- The goal of these tests is to evaluate a concern
What this means for you
- Not all tests performed during a preventive visit are considered preventive
- The clinic may bill additional lab work differently
- Coverage depends on the services you receive and how they are billed
Consider asking
- “Are these tests part of preventive care?”
- “Do I need to complete these today?”
Your plan covers preventive services at no cost when they follow preventive care guidelines, but the clinic may bill additional tests to evaluate a concern differently. Before you undergo a new test, consider asking if the test is part of preventive care.
Scenario 4: Managing an ongoing health condition
You schedule your annual visit and also check an ongoing condition, such as diabetes or high blood pressure. During the visit, your doctor reviews your condition and may adjust your treatment. While your annual visit is preventive care, the portion focused on managing a condition is diagnostic care.
What’s happening
- Your visit included a preventive checkup
- Your doctor reviewed an existing condition during the appointment
- Part of the visit focused on managing that condition
What this means for you
- Care related to an existing condition is not considered preventive
- The clinic may bill this portion of the visit separately
- Coverage depends on the services you receive and how they are billed
Consider asking
- “Will managing this condition be billed separately?”
- “Should I schedule a follow-up visit for this?”
Your plan covers preventive services at no cost when they follow preventive care guidelines and you see an in-network provider, but the clinic may bill care related to an existing condition differently. Consider asking how managing your condition during an annual checkup may affect your coverage.
See the screenings and vaccines you need to stay healthy.
Visit MyHealthFinder to get personalized recommendations for preventive care.
Preventive care is covered at no cost
Preventive care includes the services you get as part of a routine wellness exam. Your primary care doctor will assess your overall health and recommend the screenings and vaccines you need. You pay $0 out-of-pocket for many in-network preventive care services.
Preventive care for men and adults
- Routine PSA test, one annually for men age 40 and older
- Annual physical exam
- Screenings based on your age and health, such as colorectal cancer, diabetes, blood pressure, cholesterol, depression, HIV, and other recommended screenings
- Hemoglobin A1C, age 18 and older
- Preventive counseling and health risk assessments
- Recommended vaccines based on your age and health
- Obesity screening and nutrition counseling
- Urinalysis
- Routine electrocardiogram (EKG)
- Chest X-ray
Find recommended screenings based on your age and health, and understand how preventive care guidelines and your benefits determine what is covered at no cost.
Incentives for Consumer-Driven Option members
Earn rewards for staying on top of preventive care
Under your plan, you may receive a $25 wellness incentive added to your Personal Care Account (PCA) when eligible preventive services are completed according to plan guidelines.
For men, applicable incentive opportunities may include:
- Annual physical exam
- Colonoscopy or Cologuard
Questions about preventive care for men
Answers to these questions can help you understand what preventive care includes, what is covered at no cost, when costs may apply, and how to stay on track with recommended screenings and visits.
What men’s health screenings should I be sure to get?
Preventive care for men includes routine screenings that help detect health concerns early and monitor important risk factors over time.
Key screenings to keep you on track
- Prostate cancer screening, including PSA testing
- Colorectal cancer screening starting at age 45
- Blood pressure screening
- Cholesterol screening
- Diabetes screening, including A1C testing
- Depression and behavioral health screening
- HIV and other recommended preventive screenings
What to know
- Some screenings follow age-based guidelines
- Others depend on your health history and risk factors
- Your doctor may recommend additional screenings based on your health.
Why this matters
- Many serious conditions develop without symptoms
- Staying up to date helps detect issues earlier, when they may be easier to treat
- Regular screenings help your doctor track changes over time
What to do
- Ask your doctor which screenings you need this year
- Schedule recommended screenings before leaving your appointment
- Follow recommendations for any follow-up care
Why are wellness screenings important for men?
Wellness screenings help your doctor monitor health risks that may not cause symptoms right away. These checks are an important part of preventive care because they help identify concerns before they become more serious.
Key wellness screenings may include
- Blood pressure screening
- Cholesterol screening
- Diabetes screening, including A1C testing
- Depression screening
- HIV screening
Why this matters
- High blood pressure, high cholesterol, and diabetes can develop without obvious symptoms
- Early detection can help reduce the risk of more serious health problems
- Regular screening gives your doctor information to guide next steps
What to ask
- “Am I due for blood pressure, cholesterol, or diabetes screening?”
- “Are these tests preventive, or are they related to managing a condition?”
- “What should I do if my results are outside the normal range?”
When should I start getting a PSA test?
PSA testing is a preventive screening that can help check for signs of prostate cancer.
APWU Health Plan coverage includes
- One routine PSA test annually for men age 40 and older
- What to know
- PSA testing may be recommended based on your age, health, and risk factors
- Your doctor can help you decide whether PSA screening is right for you
- Follow-up testing after an abnormal result may be considered diagnostic
Why this matters
- Prostate cancer may not cause symptoms early
- Routine screening can help detect concerns sooner
- Understanding whether your test is preventive or diagnostic can help reduce billing confusion
What to ask
- “Am I due for a PSA test this year?”
- “Is this being ordered as routine preventive screening?”
- “If I need follow-up testing, how will it be billed?”
When should I start colorectal cancer screening?
Colorectal cancer screening helps detect changes early and can help prevent cancer or find it when it is easier to treat.
What to know
- Colorectal cancer screening typically begins at age 45
- Screening options may include colonoscopy or at-home screening such as Cologuard
- Cologuard is covered every 3 years starting at age 45 with a physician prescription
- Your doctor can help determine which screening option is right for you
Why this matters
- Colorectal cancer may not cause symptoms early
- Screening can detect changes before they become serious
- Follow-up care may be needed if results require additional evaluation
What to ask
- “Which colorectal screening option is right for me?”
- “Am I due for screening this year?”
- “If a follow-up test is needed, will it be billed differently?”
Why are wellness screenings important for men?
Wellness screenings help your doctor monitor health risks that may not cause symptoms right away. These checks are an important part of preventive care because they help identify concerns before they become more serious.
Key wellness screenings may include
- Blood pressure screening
- Cholesterol screening
- Diabetes screening, including A1C testing
- Depression screening
- HIV screening
Why this matters
- High blood pressure, high cholesterol, and diabetes can develop without obvious symptoms
- Early detection can help reduce the risk of more serious health problems
- Regular screening gives your doctor information to guide next steps
What to ask
- “Am I due for blood pressure, cholesterol, or diabetes screening?”
- “Are these tests preventive, or are they related to managing a condition?”
- “What should I do if my results are outside the normal range?”
Are all screenings and tests during my visit covered at no cost?
Not always. Preventive care is covered at no cost when it meets specific guidelines, but not every service you receive during a visit is preventive.
Covered at no cost when
- The service follows preventive care guidelines
- It is recommended based on your age and health
- You see an in-network provider
May be billed separately if
- Your doctor orders a test to evaluate symptoms
- You need additional testing beyond a routine screening
- You require follow-up care after an abnormal result
- Your visit includes care to manage an existing condition
Important to know
- A single visit can include both preventive and diagnostic care
- The purpose of the service determines how it is billed
- Coverage depends on the services you receive and how they are billed
What to ask
- “Is this test considered preventive?”
- “Does it follow preventive care guidelines?”
- “Will my plan cover this at no cost?”
What’s the difference between a preventive visit and a visit for a health concern?
Knowing the difference between preventive care and diagnostic care is key to understanding your coverage.
Preventive visit
- Focused on staying healthy
- Includes routine checkups, screenings, and vaccines
- Done when you have no symptoms
- Often covered at no cost when guidelines are followed
Visit for a health concern, or diagnostic care
- Focused on evaluating symptoms or a specific issue
- May include additional tests, labs, or imaging
- May involve managing a condition
- May include out-of-pocket costs
What to know
- Both types of care can happen during the same visit
- The portion of the visit used to evaluate a concern is not considered preventive
- This is one of the most common reasons members receive a bill after a routine visit
What to ask
- “Is today’s visit preventive, diagnostic, or both?”
- “If I bring up this concern, will it change how the clinic bills my visit?”
How do I stay on track with preventive care as I get older?
Preventive care becomes more important over time as your health and screening recommendations change.
What to know
- Some screenings become more important with age, including:
- PSA testing for men age 40 and older
- Colorectal cancer screening starting at age 45
- Blood pressure, cholesterol, and diabetes screenings based on your health and risk factors
Other screenings and vaccines continue based on your age, health history, and doctor’s recommendations.
How to stay on track
- Schedule your annual checkup each year
- Ask your doctor what screenings you need now and next
- Schedule follow-up screenings before leaving your visit
- Use reminders or checklists to stay organized
Medicare note
Under Medicare, you can get a yearly wellness visit to develop or update your personalized plan to help prevent disease or disability, based on your current health and risk factors. The yearly wellness visit is not a physical exam.
Why this matters
- Preventive care helps detect changes early
- Staying consistent helps avoid missed or delayed screenings
- Regular visits help your doctor understand your health over time
What to ask
- “What screenings should I be planning for this year?”
- “What should I expect in the next few years?”
- “Are there age-based screenings I should be preparing for?”