The Affordable Care Act has brought a lot of positive changes in the area of women’s health, not the least of which is coverage for preventative services like mammograms and pap smears. However, there are still some services that are important to women’s health, but are not covered by insurance; or, they are only covered for women of certain ages, or under certain circumstances.
Below is a list of common screening tests, as well as the current guidelines for when you should be tested. These guidelines were created by the U.S. Preventative Services Task Force and are based on national averages. Your doctor could make different recommendations.
There are two different types of screening test: those that are for overall health, and those that are specific to women.
The tests for overall health include blood pressure, cholesterol, diabetes, and colorectal cancer. Women who are sexually active should also consider STD testing including gonorrhea, HIV, syphilis, and herpes.
· Blood pressure should be tested every two years, starting at age 18, if your last reading was lower than 120/80; and annually if your blood pressure is between 120/80 and 139/89. A blood pressure at or above 140/90 is considered hypertensive and the frequency of screening depends on your doctor and treatment plan. Additionally, if your blood pressure is in the normal range, but you have a family history of hypertension, are taking hormonal birth control, or have other risk factors, your doctor could recommend more frequent screening.
· Cholesterol should be screened regularly, starting at age 20, if you have a family history of high cholesterol or an increased risk for heart disease. Your doctor should determine the frequency.
· Colorectal cancer screening should start at age 50, unless you have a family history or increased risk. Your doctor should determine the frequency and type of test, depending on your personal health history.
· Diabetes testing should start as early as age 18, especially if you have a family history, if your blood pressure is higher than 135/80, or if you are taking blood pressure medication. Your doctor determines the frequency of testing.
· STD testing should occur at regular intervals, starting at age 18, if you are sexually active. However, women who become sexually active before age 18 will need to start screening sooner, pregnant women of all ages should be tested.
Tests specific to women include bone mineral density tests, mammograms, and pap tests.
· Screening for bone mineral density should start at age 50 if you have a high risk for osteoporosis; otherwise the screening should start at age 65. However, women who take certain types of hormonal birth control might need to start screening much earlier.
· Breast cancer screening is recommended once every two years starting at age 50, through age 75. Women under age 50 with a family history of breast cancer, or other risk factors, could start screening much earlier.
· The currently guidelines recommend a pap test every three years, starting at age 21, and then a pap and HPV test every five years after age 30. However, women with a family history of cervical cancer, or a personal history of abnormal pap results could need annual screening.
What Happens if you Fall Outside the Guidelines?
As we stated before, those guidelines are based on average cases and don’t necessarily apply to all women. However, some insurance companies might not cover certain screening tests if you fall outside of those guidelines.
For example, where insurance will cover a bone density scan as a preventative procedure on a 65 year-old, it might not cover the same procedure in a 45 year-old who has been using hormonal birth control for several years.
If your doctor determines that you need to have a procedure done outside of the normal guidelines, there are options.
Your first step is to check with your insurance company. Some companies will cover these procedures, but they may require a doctor’s authorization or count the cost of the procedure toward your deductible. Some companies, like US Health Group, use social media and other online channels to provide consumer information on a variety of topics, including where to go for information on covered services.
If your insurance company will not cover the procedure, you could determine the cost to see if it is feasible for you to pay out-of-pocket.
If paying out of pocket is too expensive, you could consider finding an insurer who will cover you having the procedure; and then changing insurance companies, or postponing the procedure until you are able to change during an open enrollment period.
Keep in mind that if your doctor considers the procedure medically necessary, he may be able to convince the insurance company that they need to cover you, even if they wouldn’t under other circumstances. This is why it’s important to check with your insurer and share that information with your doctor before making any other plans regarding your coverage or paying out-of-pocket.