Preventive care for women
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 well-being and minimize health risks.
What to focus on to stay healthy
Women’s health can change over time. Getting regular screenings, checkups, 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, understand your personal risk factors, and make informed decisions as your health evolves.
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
- Plan ahead for screenings and follow-up care
- Make informed decisions about your health with your doctor
Stay on track with breast cancer screenings
Mammograms can detect breast cancer early, often before symptoms appear. They are typically recommended every 1–2 years starting at age 40.
Cervical cancer screenings are key to early detection
Cervical cancer screenings can detect abnormal cell changes before cancer develops. They are typically recommended starting at age 21.
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.
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
The examples below show how a preventive visit can change when additional care is needed and how that may affect how services are billed.
Scenario 1: Bringing up a new concern
During your annual checkup, you mention a new symptom, like ongoing fatigue, breast discomfort, 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 a follow-up test after a screening
You go in for a routine mammogram as part of preventive care. After reviewing the results, your doctor asks you to come back for additional imaging to take a closer look. This is a normal next step. While your initial screening is preventive, the follow-up testing focuses on evaluating a finding and is 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. 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.
Women-specific preventive care
- Well-woman visits
- Cervical cancer screenings (Pap tests)
- Breast cancer screenings based on age and guidelines
- Contraceptive methods and counseling
- Screening and counseling for sexually transmitted infections
- Screening for interpersonal and domestic violence
Preventive care for all adults
- Annual physical exam
- Screenings based on your age and health, such as colorectal cancer, diabetes, blood pressure, cholesterol, depression, HIV, and other recommended screenings
- Preventive counseling and health risk assessments
- Recommended vaccines based on your age and health
- Obesity screening and nutrition counseling
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:
- An annual physical exam
- Mammogram
- Cervical cancer screening
- Colonoscopy/Cologuard
Questions about preventive care for women
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 women’s health screenings should I be sure to get?
Preventive care for women includes both general adult screenings and women-specific services that are important for early detection and long-term health.
Key screenings to keep you on track:
- Breast cancer screenings (mammograms)
- Cervical cancer screenings (Pap tests)
- Colorectal cancer screenings (starting at age 45)
- Blood pressure, cholesterol, and diabetes screenings
- Depression and behavioral health 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
Why this matters:
- Many serious conditions develop without symptoms
- Staying up to date helps detect issues earlier, when they may be easier to treat
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
When should I start getting mammograms and how often should I be tested?
Mammograms are an important part of preventive care for women and help detect breast cancer early.
APWU Health Plan coverage includes:
- Ages 35–39: One screening during this 5-year period
- Age 40 and older: One screening every calendar year
What to know:
- Includes standard and 3D mammograms
- Must follow preventive care guidelines to be covered with no costs
- Your doctor may recommend a different schedule based on your risk factors
Why this matters:
- Early breast cancer may not cause symptoms
- Regular screening helps detect changes
What to ask:
- “Am I due for a mammogram this year?”
- “Is this a routine preventive screening?”
- “If I need follow-up imaging, will I get a bill?”
How often should I get a Pap test or cervical cancer screening?
Cervical cancer screenings are part of well-woman preventive care and help detect abnormal cell changes early.
What to know:
- Typically begins at age 21
Frequency depends on:
- Your age
- Your health history
- Prior screening results
- Often included as part of a well-woman visit
Why this matters:
- Screenings can detect changes before cancer develops
- Early detection helps reduce long-term health risks
What to do:
- Ask your doctor how often you should be screened
- Stay on schedule with recommended screenings
What to ask:
- “Am I due for a cervical cancer screening?”
- “How often should I be screened based on my history?”
- “Is this considered preventive care under my plan?”
What should I expect during a well-woman visit?
A well-woman visit is preventive care focused on your overall health and recommended screenings.
Your visit may include:
- Review of your health history and risk factors
- Recommended preventive screenings
- Discussion of recommended vaccines
- Cervical cancer screening (Pap test), if needed
Counseling for:
- Reproductive health
- STI prevention
- General health and wellness
Your plan also covers:
- Contraceptive care
- STI counseling and screening
- Screening for interpersonal and domestic violence
Why this matters:
- Helps you get the recommended preventive care
- Gives you time to ask questions and plan future screenings
What to ask:
- “What preventive services do I need this year?”
- “What screenings should I schedule next?”
- “Are there any changes I should be aware of based on my age?”
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
Important to know:
- A single visit can include both preventive and diagnostic care
- The purpose of the service determines how it is 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?
Understanding 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 (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 to evaluate a concern is not considered preventive
Why this matters:
- 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:
- Mammograms (age 40+)
- Colorectal cancer screenings (ages 45–75)
- Other screenings continue based on your health and risk factors
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
- 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 isn’t a physical exam.
Why this matters:
- Preventive care helps detect changes early
- Staying consistent helps avoid missed or delayed screenings
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?”