Maximizing Your Health Insurance for Primary Care and Cancer Screening

Health insurance isn’t just for emergencies—it’s a tool that can help you stay healthy through preventive care, early detection, and chronic disease. Regular primary care visits and cancer screenings can detect potential health issues early, leading to better outcomes and lower medical costs in the long run. However, many people don’t take full advantage of their health insurance benefits when it comes to routine check-ups and screenings. Here’s how to use your insurance effectively for primary care and cancer prevention.

Understanding Your Health Insurance Coverage

Most health insurance plans cover preventive care services at no additional cost to you, thanks to the Affordable Care Act (ACA). This means that if you have a marketplace plan, employer-sponsored insurance, Medicare, or Medicaid, you likely have access to essential preventive services without copays or deductibles.

Some key services covered under most plans include:

• Annual wellness visits with a primary care provider (PCP).
• Vaccinations such as flu shots, HPV vaccination, COVID-19 boosters, and tetanus shots.
• Cancer screenings for early detection of diseases like breast, cervical, colon, prostate, and lung cancer.
• Wellness support including referral to tobacco cessation, diet counseling, and weight loss assistance.

Primary Care: Your First Line of Defense

A primary care provider, or PCP, is your go-to for managing overall health, addressing concerns, and coordinating care with specialists if needed. Regular visits to a PCP can help monitor chronic conditions like diabetes or high blood pressure, identify early signs of serious illnesses, and provide referrals for necessary screenings or tests.

Finding a PCP is an important step in managing your health. If you have health insurance, log into your insurance provider’s website and search for in-network doctors. An in-network doctor has agreed to accept your insurance plan, which will help minimize any costs you will need to pay. Call your insurance company to confirm your coverage and what copays for visits will cost.

There are different types of PCPs, mostly depending on your stage of life. Family medicine physicians treat patients at all ages. For more specialized care, internal medicine doctors treat adults and those with chronic conditions; pediatricians focus on children under 18; and geriatricians specialize in care of older adults.

Most insurance plans cover at least one annual wellness visit. Be sure to schedule your check-up and ask your doctor about any recommended screenings based on your age, gender, and family history. And, if you don’t feel comfortable with your PCP, your insurance allows you to switch to another provider. It’s important to find a doctor who listens and works well with you.

Cancer Screenings: What’s Covered?

Early detection of cancer can significantly improve survival rates. Your insurance likely covers these screenings:

• Breast Cancer: Mammograms are recommended for women starting at age 40, with most plans in Nevada covering them every year.
• Cervical Cancer: Pap smears and HPV tests are covered for people with a cervix ages 21-65.
• Colorectal Cancer: Colonoscopies or stool-based tests are covered for adults starting at age 45.
• Lung Cancer: Low-dose CT scans are covered for people aged 50-80 who currently smoke, or have quit within the past 15 years, and who have a 20-pack-year history.
• Prostate Cancer: PSA tests are generally covered, but may be based on individual risk factors.

How to Use Your Insurance Benefits Effectively

1. Check Your Plan Details – Log in to your insurance provider’s website or call customer service to confirm what preventive services are covered.
2. Find an In-Network Doctor – Visiting an in-network provider ensures you pay the lowest possible costs.
3. Schedule Annual Check-Ups – Even if you feel healthy, routine visits can catch problems before they become serious.
4. Ask About Family History – If you have a family history of cancer, your doctor may recommend additional screenings.
5. Act on Your Doctor’s Referrals – If your doctor refers you for a cancer screening, work with their scheduling team to make appointments for those exams.
6. Use Telehealth When Available – Some insurance plans cover virtual visits for certain health concerns.

Don’t Let Cost Stop You from Getting Screened

Many people avoid doctor visits due to fear of high medical bills. But preventive services like screenings and check-ups are often covered with no out-of-pocket costs. If you’re uninsured, programs like Medicaid, Medicare, or community health clinics can provide low-cost or free screenings.

Some health clinics in Nevada also offer services on a sliding fee scale. This means that you are charged for services based on your income and ability to pay, so those with lower incomes pay less. Some services may even be offered free.

In Nevada, Access to Healthcare Network also offers a medical discount program for people who do not have health insurance. Members pay a small, income-based membership fee—usually about $450-$500 per year—for access to the discounted provider network. Then, members can visit any of the participating healthcare providers for a reduced rate, which must be paid in full at the time of the visit.

Learn more about health insurance at Triage Cancer.