If I have a standard annual physical as a man aged 53, am I charged for the lab work on my urine and blood drawn? Such as lab test for PSA for prostate cancer? Such as cholesterol testing? Is the only thing that is free the actual doctor physical exam? It is all part of the annual preventative care visit, so it should all be covered, no?
Similarly, for a colonoscopy, the preventative care coverage under Obamacare means that the doctor is covered. What about the exam center? Is it covered? What about any anethesia and anethesiologist? What about the prescription liquid stuff I have to drink before to cleanse my colon? What about the initial visit to the doctor before my procedure?
For most preventive services, only the screening itself is covered at no charge. The actual services required can be subject to cost sharing, and that is based on what plan you have.
All ACA-compliant private Major Medical plans (including Marketplace plans) cover the costs for colonoscopy as a screening test; patients may be charged for some services. You may have to pay part of the costs of anesthesia, bowel prep kit, pathology costs, and a facility fee (where the procedure is performed).
Colonoscopies that are done to evaluate specific problems, such as intestinal bleeding or anemia, are usually classified as diagnostic – and not screening – procedures. If that’s the case, you may have to pay any required deductible and copay. The same is true if the colonoscopy was done after a positive stool test (such as the FOBT or FIT) or an abnormal barium enema or colonography. Some insurance plans also consider a colonoscopy diagnostic if something is found (like a polyp) during the procedure that needs to be removed or biopsied.
Before you get a screening colonoscopy, ask your insurance company how much you should expect to pay for the exam. Find out if this amount could change based on findings during the procedure. Learn more at cancer.org.
Only the following preventive care is covered at no cost for adult men. The rest is covered under your plan's cost sharing amounts. See our preventive care page for covered services for women and children:
- Abdominal Aortic Aneurysm one-time screening for men of specified ages who have ever smoked
- Alcohol Misuse screening and counseling
- Aspirin use to prevent cardiovascular disease for men and women of certain ages
- Blood Pressure screening for all adults
- Cholesterol screening for adults of certain ages or at higher risk
- Colorectal Cancer screening for adults over 50
- Depression screening for adults
- Diabetes (Type 2) screening for adults with high blood pressure
- Diet counseling for adults at higher risk for chronic disease
- HIV screening for everyone ages 15 to 65, and other ages at increased risk
- Immunization vaccines for adults–doses, recommended ages, and recommended populations vary:
- Obesity screening and counseling for all adults
- Sexually Transmitted Infection (STI) prevention counseling for adults at higher risk
- Syphilis screening for all adults at higher risk
- Tobacco Use screening for all adults and cessation interventions for tobacco users