Navigating Insurance for Health Screenings by Age and Gender

Name: Navigating Insurance for Health Screenings by Age and Gender
Item: Navigating Insurance for Health Screenings by Age and Gender
Author: Nathan Paulus

Health insurance may cover preventive screenings. Knowing the appropriate health screenings by age and gender can help reduce expenses and maximize benefits.

By Nathan Paulus

Edited by Rae Osborn

Updated: November 1, 2024

Advertising & Editorial Disclosure

Regular health screenings assist in early detection of potential health issues and often lead to faster and more economical treatments. These screenings are covered by most health insurance plans in their primary coverage. Knowing the specifics of your plan can help you utilize these covered screenings, minimize out-of-pocket expenses and fully leverage your plan's benefits for improved health outcomes.

Despite leading in health spending among developed nations, many Americans overlook the advantages of preventive health care.

Only 8% of Americans consistently get preventive screenings. On a broader scale, just 15 out of 50 states report above-average metrics in preventive health care.

The Institute of Medicine (IOM) suggests that the U.S. loses $55 billion annually due to missed preventive measures, accounting for roughly 30 cents of every health care dollar spent.

Sources: National Library of Medicine

Long-Term Financial Benefits of Preventive Health Screenings

Although preventive health screenings could come with an upfront cost, their long-term financial benefits are worth considering. Preventive care can lead to less intensive treatments, reduced time off work and improved quality of life by identifying diseases early before they become severe or chronic.

Avoidance of Sudden, Severe Health Expenses

Diseases identified in their early stages often require less intensive – and consequently less costly – treatment, which can help avoid the potential financial stress of sudden, high-cost medical bills.

Health Care Cost Management

Understanding your risk factors through screenings can guide lifestyle changes, reduce long-term health care expenditures and lead to consistent work productivity.

Better Insurance Rates

Some insurance companies offer discounts or better rates for policyholders who regularly complete preventive health screenings, indicating proactive health management.

Extended Health Span

Regular screenings can contribute to a longer, healthier life, potentially reducing long-term health care costs by delaying or preventing age-related medical conditions.

Prevention of Disease Spreading

Certain screenings benefit individuals and the community by preventing the spread of infectious diseases and reducing collective health care costs.

Recommended Health Screenings by Age and Gender

Health requirements differ between men and women across various age groups, underscoring the need for tailored screenings. Knowing which health screenings are appropriate based on gender and age can also aid in developing a more effective financial plan.

Recommended Health Screenings for Men

Below is a table of health screenings for men, categorized by age group, as recommended by MedlinePlus. Consult your health care provider to determine the most suitable screenings for your health needs.

Screening Type	18-39	40-64	65+
Blood Pressure Screening	At least once every three to five years for those with no risk factors.	At least once yearly.	At least once yearly.
Cholesterol Screening	Screening should begin at age 20 for men with known risk and 35 for men without risk.	Every five years with normal cholesterol level. More often, if you have risk factors.	Start at age 45 or earlier with risk factors. Repeat every five years or sooner based on health changes or conditions.
Diabetes Screening	Starting at age 35 and then repeated every three years if no risk factors are present.	Every three years.	Every three years or more if you have risk factors.
Dental Exam	Once or twice yearly for cleaning and examination.	Once or twice yearly for an exam and cleaning.	Once or twice a year.
Eye Exam	Every five to ten years before age 40 for those without vision problems or every two years if you have vision problems. Annual exams are recommended for those with diabetes.	Every two to four years between ages 40 to 54 and yearly to three years from ages 55 to 64. Annual exams are recommended for those with diabetes.	Yearly to two years. Annual exams are recommended for those with diabetes.
Infectious Disease Screening	One-time test for hepatitis C at age 18-79. One-time test for HIV at age 15-65.	Screenings based on lifestyle and medical history.	Screenings for hepatitis C, HIV and other infections based on lifestyle and medical history.
Physical Exam	Periodically, even if healthy.	Periodically assess physical health and update on vaccinations.	Periodic visits for disease screening, risk assessment and lifestyle encouragement.
Skin Exam	Regular checks, especially for high-risk individuals.	Regular checks, especially for high-risk individuals.	Regular checks, especially for high-risk individuals.
Colorectal Cancer Screening	Not routinely recommended.	Consider screening if under age 45 with a family history of colon cancer or polyps.	Regular screenings should be done until age 75.
Lung Cancer Screening	Not routinely recommended.	Annual screening for those who have a smoking history and meet specific criteria.	Consider screening at age 50 to 80 years and if you have a smoking history and currently smoke.
Osteoporosis Screening	Not routinely recommended.	Consider screening if between age 50 to 64 and have risk factors for osteoporosis.	Bone density test for men age 65 or older.
Hearing Test	Not routinely recommended.	Not routinely recommended.	Test if symptoms of hearing loss are present.
Abdominal Aortic Aneurysm Screening	Not routinely recommended.	Not routinely recommended.	Ultrasound screening for those age 65 to 75 who have smoked.

Sources:

Recommended Health Screenings for Women

The following table outlines health screenings specifically recommended for women, categorized according to different age brackets, following MedlinePlus guidelines. Discuss with your health care professional to customize these screenings based on your health circumstances.

Screening Type	18-39	40-64	65+
Blood Pressure Screening	At least once every three to five years for those with no risk factors.	At least once yearly.	At least once yearly.
Cholesterol Screening	Screening should begin at age 20 for women with known risk and 45 for women without risk.	Every five years with normal cholesterol level. More often, if you have risk factors.	Start at age 45 or earlier with risk factors. Repeat every five years or sooner based on health changes or conditions.
Diabetes Screening	Starting at age 35 and then repeated every three years if no risk factors are present.	Every three years.	Every three years or more if you have risk factors.
Dental Exam	Once or twice yearly for cleaning and examination.	Once or twice yearly for an exam and cleaning.	Once or twice a year.
Eye Exam	Every five to ten years before age 40 for those without vision problems or every two years if you have vision problems. Annual exams are recommended for those with diabetes.	Every two to four years between ages 40 to 54 and yearly to three years from ages 55 to 64. Annual exams are recommended for those with diabetes.	Yearly to two years. Annual exams are recommended for those with diabetes.
Infectious Disease Screening	One-time test for hepatitis C at age 18-79. One-time test for HIV at age 15-65. Pregnant women should be screened at every pregnancy.	Screenings based on lifestyle and medical history. Pregnant women should be screened at every pregnancy.	Screenings for hepatitis C, HIV and other infections based on lifestyle and medical history.
Physical Exam	Periodically, even if healthy.	Periodically assess physical health and update on vaccinations.	Periodic visits for disease screening, risk assessment and lifestyle encouragement.
Skin Exam	Regular checks, especially for high-risk individuals.	Regular checks, especially for high-risk individuals.	Regular checks, especially for high-risk individuals.
Breast Cancer Screening (Mammogram)	Not typically recommended for most women under age 40. Discuss with your provider if having an increased risk.	Yearly to two years for women ages 50-75, depending on the risk factors.	Consider mammograms yearly to two years up to age 75. Discuss mammogram frequency after age 75 with your provider.
Cervical Cancer Screening (Pap Test)	Screening should start at age 21 unless advised otherwise.	Women ages 30 through 65 should consider a Pap test every three years or an HPV test every five years. Those treated for precancer should continue Pap tests for 20 years after treatment.	Not routinely recommended.
Colorectal Cancer Screening	Not routinely recommended.	Consider screening if under age 45 with a family history of colon cancer or polyps.	Regular screenings should be done until age 75.
Lung Cancer Screening	Not routinely recommended.	Annual screening for those who have a smoking history and meet specific criteria.	Consider screening at age 50 to 80 years and if you have a smoking history and currently smoke.
Osteoporosis Screening	Not routinely recommended.	Consider screening if between age 50 to 64 and have risk factors for osteoporosis.	Bone density test for women age 65 or older.
Hearing Test	Not routinely recommended.	Not routinely recommended.	Test if symptoms of hearing loss are present.

Sources:

A person talking to a health care provider next to a white board.

Insurance Coverage for Preventive Care

Since the introduction of the Affordable Care Act (ACA) over a decade ago, most health insurance is legally mandated to cover a range of recommended preventive health screenings. This applies to all private plans, whether individual, small group or large group markets, except those classified as "grandfathered" plans. This mandate means these screenings won't require copayments, deductibles or co-insurance. Note that the exact coverage details may vary — always consult with your insurance provider for coverage details.

Non-Grandfathered Private Health Insurance Plans

Under Section 2713 of the Public Health Service (PHS) Act, non-grandfathered health plans and insurers must provide specific preventive services without cost-sharing. These services include:

Evidence-based services for adults with an "A" or "B" rating from the United States Preventive Services Task Force (USPSTF).
Routine immunizations recommended by the Advisory Committee on Immunization Practices (ACIP), including vaccines for flu, meningitis, HPV, hepatitis and COVID-19.
Evidence-based recommendations from the Health Resources and Services Administration (HRSA)-supported Women's Preventive Services Guideline, include well-woman visits, FDA-approved contraceptives, breastfeeding support and screenings for conditions like intimate partner violence and HIV.
Preventive services for children and adolescents, as recommended by HRSA's Bright Futures Project, without cost-sharing.

Medicare

Medicare offers a broad spectrum of preventive care options to its beneficiaries. Coverage details can vary depending on factors like the type of Medicare plan and the availability of a participating health care provider.

Medicare Part B: Medicare Part B covers an extensive range of preventive services if you meet eligibility rules and guidelines. Note that coverage specifics may depend on the details of your chosen plan.
Original Medicare: Original Medicare typically includes most preventive services without charge as long as they are accessed through a participating provider. Services recommended by the U.S. Preventive Services Task Force are fully covered, but some other services might involve a cost-share. Additional fees can be incurred if services are obtained from non-participating or opting-out providers.
Medicare Advantage Plans: Under Medicare Advantage Plans, preventive services that Original Medicare covers in full are usually free of charge when visiting an in-network provider. These plans must offer these services without imposing deductibles, copayments or co-insurance following Medicare's eligibility requirements. Certain preventive services not fully covered by Original Medicare may incur charges, especially if you visit out-of-network providers. Ensure the health services you seek are within your insurance network.

Medicaid Expansion Plans

States offering Medicaid expansion plans are mandated to provide comprehensive preventive services coverage to non-elderly individuals whose earnings are up to 133% of the federal poverty level ($16,611 for an individual or $34,247 for a family of 4 in 2019). This means that these plans must cover, without any additional costs to the beneficiary, all the preventive services specified in Section 2713 of the PHS Act, similar to the requirements for non-grandfathered private health insurance plans.

Maximizing Insurance Coverage for Health Screenings

Effectively managing your health insurance coverage can greatly reduce out-of-pocket expenses and yield considerable long-term financial benefits, particularly for preventive health screenings. Here are some practical tips to help you get the most out of your health insurance:

Understand Your Policy

Familiarize yourself with the health screenings your policy covers. Preventative care is often fully covered, but the exact screenings may differ between policies.

Leverage Wellness Visit

Most insurance plans include annual wellness visits. Use these visits to discuss necessary screenings with your provider and make the most out of your coverage.

Stay In-Network

Use health care providers within your insurer's network. In-network providers usually offer services at lower costs, minimizing your expenses.

Track Screenings

Keep a record of your screenings. Avoid unnecessary duplication of tests, as insurance might not cover these.

Discuss Costs Upfront

Talk with your provider about the costs of specific screenings if your insurance does not cover them.

Request Generic Tests

Ask your health care provider for generic versions of any tests. These are usually cheaper but just as effective.

Stay Updated on Policy Changes

Keep track of any changes in your insurance policy, particularly those affecting preventive screenings, to ensure you're always well-informed and can adjust as needed.

Shop Around

Explore different insurance providers to compare rates and coverage. This can help you find a more cost-effective health insurance option.

A person sitting and looking at bills to pay.

Paying for Health Screenings Without Insurance

Several options are available to help cover the costs of health screenings for those without insurance or with inadequate coverage. Each solution caters to different needs and situations. Here are some alternatives and suggestions to help manage the expenses of health screenings:

Health Savings Account (HSA)

You can utilize an HSA, a tax-advantaged savings account tied to a high-deductible health plan (HDHP), to assist in handling health care expenses. Contributions, withdrawals for qualified medical expenses and interest earnings in HSA are tax-free.

Flexible Spending Account (FSA)

This employer-sponsored plan allows employees to allocate pre-tax dollars to cover qualified medical expenses, including health screenings.

Community Health Clinics

These clinics often provide services on a sliding scale based on income, including basic screenings and preventive care. Use HRSA's health center finder to locate health centers in your area.

Health Fairs

Local health fairs may offer free or low-cost screening opportunities and connect individuals to affordable health care resources in the community.

Direct Negotiation With Health Care Providers

Discuss your financial constraints with doctors or clinics. They might offer lower fees or discounts for upfront payments. Many are open to setting up payment plans for pricier screenings.

Discounted Screening Programs

Many health organizations and local nonprofits offer discounted or even free screenings. Check the eligibility criteria, as some cater to specific income groups or demographics.

Plan and Budget for Essential Screenings

Prioritize essential screenings and allocate funds accordingly. Research and compare costs across various providers to get the best value.

Although these alternatives can provide relief, they are not substitutes for comprehensive health insurance. Plan wisely and consider all your health care needs.

Additional Resources

For further reading on health screenings and financial aid programs, consider exploring the following:

American Heart Association - Heart Health Screenings: This organization focuses on cardiovascular health and offers screening guidelines for heart diseases, cholesterol levels and blood pressure.
American Diabetes Association - Diabetes Risk Test: This online tool helps individuals assess their risk for type 2 diabetes and offers guidance on potential next steps based on the results.
Centers for Disease Control and Prevention (CDC) - Preventive Health Screenings: This resource offers comprehensive information on various health screenings, their importance and recommended ages for each screening. It's a trusted source for understanding the basics of preventive care.
Mayo Clinic - Health Screenings: The Mayo Clinic provides detailed insights into different health screenings, their procedures and benefits. It's a reputable source for in-depth medical information.
MedlinePlus - Health Screenings: Sponsored by the National Library of Medicine, MedlinePlus offers a wealth of information on different health screenings, their procedures and the diseases they can detect.
National Cancer Institute - Cancer Screening Overview: The NCI's resource provides a thorough overview of various cancer screenings, their significance and guidelines on when and how often they should be done.

About Nathan Paulus

Nathan Paulus is the Head of Content Marketing at MoneyGeek, with nearly 10 years of experience researching and creating content related to personal finance and financial literacy.

Paulus has a bachelor's degree in English from the University of St. Thomas, Houston. He enjoys helping people from all walks of life build stronger financial foundations.

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sources

Federal Register. "Coverage of Certain Preventive Services Under the Affordable Care Act." Accessed October 24, 2024.
Federal Register. "Federal Register / Vol. 78, No. 135 / Monday, July 15, 2013 / Rules and Regulations." Accessed October 24, 2024.
HealthCare.gov. "Affordable Care Act (ACA) - Glossary." Accessed October 24, 2024.
HealthCare.gov. "Grandfathered Health Plan - Glossary." Accessed October 24, 2024.
Medicare.gov. "How Original Medicare Works." Accessed October 24, 2024.
Medicare.gov. "Preventive Services." Accessed October 24, 2024.
Medicare.gov. " Understanding Medicare Advantage Plans." Accessed October 24, 2024.
Medicare.gov. "Health Screenings for Men Age 18 to 39." Accessed October 24, 2024.
Medicare.gov. "Health Screenings for Men Age 40-64." Accessed October 24, 2024.
Medicare.gov. "Health Screenings for Men Age 65 and Older." Accessed October 24, 2024.
Medicare.gov. "Health Screenings for Women Age 18 to 39." Accessed October 24, 2024.
Medicare.gov. "Health Screenings for Women Age 40 to 64." Accessed October 24, 2024.
Medicare.gov. "Health Screenings for Women Age 65 and Older." Accessed October 24, 2024.
National Library of Medicine. "Preventive Healthcare Policies in THE US: Solutions for Disease Management Using Big Data Analytics." Accessed October 24, 2024.