Examples of preventive and non-preventive services
Before you have a test or service, it is good to understand if it will be covered as a preventive service in your plan. Remember - if the service is not preventive, your deductible, copays and coinsurance may apply. The examples below may help.
Colon cancer screening (colonoscopy or sigmoidoscopy)
It's preventive when...
You have no symptoms, and your doctor wants to screen for signs of colon cancer based on your age or family history.
If a polyp is found and removed during your preventive colonoscopy, the colonoscopy and polyp removal are preventive. If the polyp is sent for testing this is also considered preventive.
It's diagnostic when...
You're having a health problem, like bleeding or irregularity.
Breast cancer screening
It's preventive when...
You have no symptoms, and you have a mammogram or digital breast tomosynthesis based only on your age or family history.
It's diagnostic when...
You're having a health problem like pain, or you feel a lump. If you have a lump removed and sent to a lab for testing, it's also considered diagnostic.
Diabetes screening
It's preventive when...
You have no symptoms, and your doctor orders a blood glucose test to check your blood sugar control.
It's diagnostic when...
You're diagnosed with diabetes, and your doctor checks your A1c.
Metabolic panel
It's preventive when...
Never.
It's diagnostic when...
Always. Studies show a metabolic panel isn't the best test for finding or preventing illnesses.
Osteoporosis screening
It's preventive when...
You have no symptoms, and you have a bone density test to screen for early signs of osteoporosis simply based on your age or family history.
It's diagnostic when...
You're having a health problem, or your doctor wants to determine the success of a treatment.
Prostate-specific antigen (PSA) test
It's preventive when...
Never.
It's diagnostic when...
Always. National guidelines don't recommend this test because it gives many false results.
Urinalysis
It's preventive when...
Never.
It's diagnostic when...
Always. New national guidelines say there's no need for this test unless you have symptoms.