Doctors HealthCare Plans wants you to get the preventive care you need!
Your Evidence of Coverage include details on the preventive care covered by your plan however here’s a summary of the preventive tests, screenings, vaccinations and exams that are covered at no cost to you.
Preventive vs. diagnostic tests
Remember, the services listed here are only preventive when you have no symptoms – if your doctor orders a test or screening because you are having symptoms, the test is considered “diagnostic.” That means you may have to pay a cost share- please refer to your Evidence of Coverage for more information.
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Get your annual wellness visit
Doctors HealthCare provides every Medicare Advantage plan member with an annual wellness visit, and there’s no cost to you.
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Abdominal aortic aneurysm (AAA) screening
Who is covered: Those with certain risk factors for AAA, specifically for men aged 65-75 who have ever smoked.
When: Once in a lifetime, with a referral from your doctor.
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Alcohol misuse -screening and counseling
Who is covered: All members
When: Annually
If you screen positive for alcohol misuse, you can get up to four in-person counseling visits per year (you must be competent and alert during counseling).
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Bone mass measurement
Who is covered: Members who are at risk of losing bone mass or at risk of osteoporosis.
When: Once every 24 months, or more frequently if medically necessary.
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Breast Cancer Screening (Breast Exams and Mammograms)
Who is covered: All female members
When: Breast exams: monthly; Breast Cancer screening: every 12 months for women aged 40 and older. Baseline mammogram between ages of 35-39, Clinical breast exams once every 24 months.
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Cardiovascular disease risk reduction visit
Who is covered: All members
When: Annually
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Cardiovascular disease testing
Who is covered: All members
When: Once every 5 years, when ordered by a doctor
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Cervical (Pap test) and vaginal (pelvic) cancer screening
Who is covered: All female members
When: Pap test and pelvic exams are covered once every 24 months. If you’re at high risk of cervical or vaginal cancer or you’re of childbearing age and have had an abnormal Pap test within the past 3 years: one Pap test every 12 months.
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Colorectal cancer screening
Who is covered: All members, see details below for each test.
When: Consult with your physician on the screening you need: Guaiac-based fecal occult blood test (gFOBT), fecal immunochemical test (FIT), DNA based colorectal screening, flexible sigmoidoscopy, colonoscopy, barium enema, Cologuard
- Colonoscopy: no age limitation and is covered once every 120 months (10 years) for patients not at high risk or 48 months after a previous flexible sigmoidoscopy for patients who aren’t at this risk for colon cancer and once every 24 months for high-risk patients after a previous screening colonoscopy.
- Computed tomography colonography: for patients 45 year and older who are not at high risk of colorectal cancer and is covered when at least 59 months have passed following the month in which the last screening computed tomography colonography was performed or 47 months have passed following the month in which the last screening flexible sigmoidoscopy or screening colonoscopy was performed. For patients at high risk for colorectal cancer, payment may be made for a screening computed tomography colonography performed after at least 23 months have passed following the month in which the last screening computed tomography colonography.
- Flexible sigmoidoscopy: for patients 45 years and older. Once every 120 months for patients not at high risk after the patient got a screening colonoscopy. Once every 48 months for high-risk patients from the last flexible sigmoidoscopy or computed tomography colonography.
- Multitarget stool DNA (FIT): for patients 45 to 85 years of age and not meeting high risk criteria. Once every 3 years.
- Blood-based Biomarker Tests (FoBT): for patients 45 to 85 years of age and not meeting high risk criteria. Once every 3 years.
Depression screening
Who is covered: All members
When: Annually.
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Diabetes screening
Who is covered: If you have any of the following risk factors: high blood pressure (hypertension), history of abnormal cholesterol and triglyceride levels (dyslipidemia), obesity or a history of high blood sugar (glucose) is eligible for a fasting glucose test. Tests may be covered if you meet other requirements, like being overweight and having a family history of diabetes.
When: Up to 2 tests per year
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Diabetes self-management training (DSMT)
Who is covered: Members with diabetes
When: As prescribed by your doctor
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Glaucoma screening
Who is covered: Medicare members with diabetes or a family history of glaucoma, African-Americans age 50 or older, and Hispanic-Americans age 65 or older
When: Annually
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Health and Wellness Education Programs
Who is covered: Members at risk for specific disease
When: As prescribed by your doctor
Hepatitis C (HCV) screening
Who is covered: Members at high risk due to: Current or past history of illicit drug use, or blood transfusions prior to 1992, for adults aged 18-79 years.
When: Once per lifetime, or annually for certain people at risk
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HIV screening
Who is covered: All members who ask for HIV screening test or who are at increased risk for HIV infection
When: Up to 8 HIV screenings every 12 months
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Immunizations
Who is covered: All member; Members at medium- to high-risk for Hepatitis B
When: See below for specific immunizations
Hepatitis B: Check with your doctor
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Influenza (flu): Annually
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Pneumococcal (pneumonia): Check with your doctor
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Covid-19: Vaccine and or booster
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Other vaccines if you are at risk and they meet Medicare Part B coverage rules. We also cover vaccines under our Part D prescription drug benefit. Please review Evidence of Coverage for details.
Lung cancer screening with low dose computed tomography (LDCT)
Who is covered: Members who meet all of these criteria:
- Age 50-77
- Asymptomatic (no signs or symptoms of lung cancer)
- Current smoker/quit smoking in the last 15 years
- Tobacco smoking history of at least 20 pack-years (one pack-year = smoking one pack per day for one year; 1 pack = 20 cigarettes)
When: Annually, when ordered by your doctor
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Medical nutrition therapy
Who is covered: Members diagnosed with diabetes or a renal disease or who have had a kidney transplant
When: As ordered by your physician
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Medicare Diabetes Prevention Program (MDPP)
Who is covered: Members that could prevent or delay type II diabetes.
When: Once per lifetime
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Obesity screening and therapy to promote sustained weight loss
Who is covered: Members with BMI greater than 30
When: Consult with your physician
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Prostate cancer screening
Who is covered: All male members age 50 or older
When: Annually for a digital rectal exam and prostate specific antigen (PSA) test.
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Vision care
Who is covered: All members
When: Annually routine eye exam.
Sexually transmitted infections (STIs), screening and counseling
Who is covered: Members at increased risk for STIs, or pregnant women
When: Every 12 months, or at certain times during pregnancy
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Smoking and tobacco use cessation (quit) counseling
Who is covered: Members who use tobacco.
When: 2 counseling quit attempts within a 12-month period. Each counseling attempt include up to four face-to-face visits
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Welcome to Medicare preventive visit
Who is covered: All members
When: Within the first 12 months you have Medicare Part B
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Last Updated: 10/17/2025