Telling the difference between a preventive visit and an office visit can be confusing, especially if you wind up having both kind of services in one visit.

The purpose of a preventive visit is to review your overall health, identify risks and find out how to stay healthy. The cost of preventive visits may be covered by your plan at no cost to you.* During your preventive care visit, your doctor may review your health risks and talk with you about:

• Your current health
• Your family health history
• Past illnesses and surgeries
• Risks you may have for specific conditions
• How to maintain a healthy lifestyle

The purpose of an office visit is to discuss or get treated for a specific health concern or condition. Depending on your health plan, you may pay for these services received during an office visit:

• Discussing or getting treatment for a specific health concern, condition or injury
• Lab work, X-rays or additional tests related to a specific health concern, condition or injury

The doctor determines if the services you receive are billed as preventive or medical. Claims are paid based on what the doctor’s office submits to your health plan.

If your doctor discusses a health problem during your preventive office visit, he or she may bill part of the visit as preventive and part as a medical office visit. Depending on your specific health plan, preventive services may be covered without a copay or deductible. For medical services, copays and deductibles may apply.

If you want to know about costs, ask your doctor for an estimate of fees before your scheduled appointment visit. You can also call the number on your member ID card. 

*If you have a grandfathered plan (a plan that was in existence on or before March 23, 2010), preventive care without out-of-pocket costs may not apply to you.