UT Benefits UT System
Living Well: Make it a Priority

UT SELECT Medical provides 100% coverage for Preventive Screenings

Free Preventive Care and Services – The UT SELECT Medical plan has always offered robust preventive care benefits including 100% preventive colonoscopy and no cost immunizations for children under 6 years of age. Now, certain additional preventive care and services will be available to you with no copayment or coinsurance as long as you see a network provider and meet certain screening eligibility requirements. Some examples of services covered under this provision include:

  • Routine physical exam
  • Well-woman exam
  • Immunizations- all ages
  • Osteoporosis screening
  • Prostate (PSA) screening

Please be aware that you may incur some cost if the preventive service is not the primary purpose of the visit or if your doctor bills for services that are not preventive. Eligible services are outlined in the Federal Regulations based on U.S. Preventive Service Task Force Recommendations. You may find more information about the covered preventive services here.

The Wellness Guide to Preventive Care

A recent government study showed that more than half of all Americans do not receive many of the important preventive services they need—that is, immunizations, screening tests for early detection of disease, and education about healthy habits and injury prevention. Why not?

  • Many Americans—44 million—have no health insurance.
  • Many people do not get continuity of care. They may have to switch doctors as they switch from one insurer to another, making it hard to keep track of what services they've had.
  • Patients may not insist on getting preventive services. They may be confused about which tests to ask for. They may not know that Medicare (and some other insurance plans) covers some of the pricier items, such as mammograms and colonoscopies, as well as the cheaper ones. They may not know that prevention is usually the most economical form of medicine—well worth budgeting for, even if insurance doesn't cover it.
  • With tests for some cancers, there's the embarrassment factor. Some people may dread being tested for colon, prostate, or breast cancer and be relieved if the doctor fails to mention it. Some people would rather not know.
  • Both doctors and patients may be confused by contradictory recommendations. What should a medical checkup consist of? Does everybody need an annual physical? Should all men get a PSA test? At what age should a woman start having mammograms? (See below for answers to such questions.)
  • Doctors may fail to ask patients about smoking and drinking, not to mention exercise habits and diet. Some HMOs don't encourage their doctors to counsel people. Some doctors think their job is to treat illness, not prevent it.
  • The watchword among insurers now is cost containment. Yet medical technologies and consumer demand for services are expanding daily. Thus, we all have to make choices. Will patients in a big HMO get more benefit from an additional MRI machine or from having their doctors take time to counsel them about exercise and a heart-healthy diet? The new MRI machine will be easier to justify, in terms of immediate, measurable benefits.

How about that annual physical?

It used to seem simple: people were advised to undergo a standardized annual or biannual "complete physical." But in the 1980s, at the request of the government, an independent committee of physicians known as the U.S. Preventive Services Task Force reviewed all evidence and evaluated the benefits and drawbacks of common screening tests and came up with recommendations. (A similar group, the Canadian Task Force on Preventive Health Care, does the same work in Canada.) That head-to-toe physical exam has now been discarded for seemingly healthy people, since it yields too few benefits for its cost. Over the long run, it doesn't pay off in terms of better health and longer life.

Some tests that used to be routinely done, such as chest X-rays, electrocardiograms (EKGs), urine tests, and complete blood counts, are now reserved for people with symptoms or risk factors. In other words, they are not general "screening" tests and are not done routinely in everyone (and as such are not covered in this article).

The U.S. and Canadian Task Forces continue to update and re-evaluate their advice, reviewing thousands of studies every year and consulting hundreds of scientific reviewers.

  • Blood pressure measurement (to detect hypertension)
    Who needs: All adults.
    How often: Once every 2 years for those with normal blood pressure.
    Comments: More frequent monitoring for those with readings of greater than 130/85 or higher—consult your doctor.

  • Cholesterol measurement
    Who needs: All adults.
    How often: Once every 5 years. More often if total or LDL ("bad") cholesterol is high, HDL ("good") is low, and/or you have risk factors.
    Comments: Those at high risk for heart disease need medical advice about life-style changes and possibly drug therapy—consult your doctor.

  • Pap smear (for early detection of cervical cancer)
    Who needs: All women with a cervix, starting at age 18, or earlier if sexually active.
    How often: If 3 annual tests are normal, then once every 3 years. More often if you smoke or have multiple sex partners or other risk factors.
    Comments: Some experts advise that woman who have never had an abnormal result can stop being screened after age 65—consult your doctor.

  • Breast cancer screening (mammography)
    Who needs: All women 50 and over; those 40-49 should discuss risk factors with a doctor.
    How often: Annually. Medicare reimburses for it.
    Comments: Clinical breast exams are also important—consult your doctor.

  • Colonoscopy screening (fecal occult blood test, sigmoidoscopy, colonoscopy)
    Who needs: Everyone 50 and over; earlier for those at high risk.
    How often: Occult blood test annually; sigmoidoscopy every 5 years or colonoscopy every 10 years.
    Comments: Digital rectal exam and X-ray with barium enema may also be done. Medicare now pays for colonoscopy—consult your doctor.

  • Prostate cancer screening (prostate specific antigen, or PSA, test; and digital rectal exam, or DRE)
    Who needs: African Americans and men with family history, DRE and PSA starting at age 40. For others, DRE, and possibly PSA, starting at 50.
    How often: DRE annually; PSA on professional advice.
    Comments: Usefulness of PSA screening for all men remains controversial—consult your doctor.

  • Diabetes screening (fasting blood glucose test)
    Who needs: Everyone 45 and older; earlier for those at high risk.
    How often: Every 3 years.
    Comments: African Americans, Hispanics, Asians, Native Americans, obese people, and those with a strong family history need more frequent screening, starting at age 30—consult your doctor.

  • Thyroid disease screening
    Who needs: Women 50 and over; those with high cholesterol or family history of thyroid disease.
    How often: On professional advice.
    Comments: Routine screening remains controversial. Talk to your doctor about risk factors.

  • Chlamydia screening
    Who needs: Women 25 and younger, if sexually active.
    How often: Annually, or more often.
    Comments: Men and women of any age who are at risk for STDs (chlamydia, gonorrhea, syphilis, and HIV) should be tested—consult your doctor.

  • Glaucoma screening
    Who needs: People at high risk: those over 65, very nearsighted, or diabetic; blacks over 40; those with sleep apnea or family history of glaucoma.
    How often: On professional advice of eye specialist.
    Comments: Many eye specialists advise screening all adults every 3-5 years, starting at age 39—consult your doctor.

  • Dental checkup
    Who needs: All adults.
    How often: Every 6 months, or on professional advice.
    Comments: Should include cleaning and exam for oral cancer—consult your doctor.

  • Tetanus/diphtheria booster
    Who needs: All adults.
    How often: Every 10 years.
    Comments: People over 50 are least likely to be adequately immunized—consult your doctor.

  • Influenza vaccine
    Who needs: Everyone 50 and over, people with lung or heart disease or cancer, and others at high risk.
    How often: Annually, in autumn.
    Comments: Even healthy younger adults can benefit and should consider getting the shot—consult your doctor.

  • Pneumococcal vaccine
    Who needs: Everyone 65 and over, and others at high risk for complications.
    How often: At least once.
    Comments: Effective against most strains of pneumococcal pneumonia; lasts at least 5-10 years—consult your doctor.

  • Rubella vaccine
    Who needs: All women of childbearing age.
    How often: Once.
    Comments: Avoid during pregnancy—consult your doctor.

  • Hepatitis B vaccine
    Who needs: All young adults, as well as adults at high risk.
    How often: On professional advice.
    Comments: All newborns should be vaccinated—consult your doctor.

  • Chickenpox vaccine
    Who needs: Anyone who has never had chickenpox.
    How often: Once. But above age 13 it requires two shots.
    Comments: Not recommended for pregnant women or those with compromised immunity—consult your doctor.

Article Source: The National Coalition on Health Care. www.nchc.org