Screening for Better Health

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What Preventive Health Screening is Free under your Plan?

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Did you know that the Affordable Care Act, better known as Obamacare, has required insurers and healthcare plans to cover a wide variety of preventive health screening tests? And most of the time, these procedures are now free for you!

Catching diseases early, before they become deadly (or better yet, preventing them entirely) is often the safest and most cost-effective way to fight sickness and stay healthy in life. That’s why all plans that are compliant with the Affordable Care Act (so basically any plans that started after 2010 in addition to Medicaid and Medicare) are required to include free screening options for their customers.

So what does that mean for you?

The short answer is: most commonly prescribed screening tests are available for free to you, with anything else likely subject to the cost-sharing part of your insurance policy. For a longer answer, you’ll want to browse through the list below of specific tests that are covered for all ACA-compliant plans, taken directly from the healthcare.gov website:

For All Adults:

  • Alcohol misuse screening and counseling
  • Aspirin use to prevent cardiovascular disease for men and women of certain ages
  • Blood pressure screening
  • Cholesterol screening
  • Colorectal cancer screening for adults over 50
  • Depression screening
  • Diabetes (Type 2) screening for adults with high blood pressure
  • Diet counseling for adults at higher risk for chronic disease
  • Hepatitis B screening for people at high risk, including people from countries with 2% or more Hepatitis B prevalence, and U.S.-born people not vaccinated as infants and with at least one parent born in a region with 8% or more Hepatitis B prevalence.
  • Hepatitis C screening for adults at increased risk, and one time for everyone born 1945 – 1965
  • 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:
  • Diphtheria
  • Hepatitis A
  • Hepatitis B
  • Herpes Zoster
  • Human Papillomavirus (HPV)
  • Influenza (flu shot)
  • Measles
  • Meningococcal
  • Mumps
  • Pertussis
  • Pneumococcal
  • Rubella
  • Tetanus
  • Varicella (Chickenpox)
  • Lung cancer screening for adults 55 – 80 at high risk for lung cancer
  • Obesity screening and counseling
  • Sexually transmitted infection (STI) prevention counseling for adults at higher risk
  • Syphilis screening for adults at higher risk
  • Tobacco Use screening for all adults and cessation interventions for tobacco users

For pregnant women or women who may become pregnant:

  • Routine Anemia Screening
  • Breastfeeding support and counseling and access to breastfeeding supplies
  • Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling (not including abortifacient drugs). This does not apply to health plans sponsored by certain exempt “religious employers.”
  • Folic acid supplements for women who may become pregnant
  • Gestational diabetes screening for women 24 to 28 weeks pregnant and those at high risk of developing gestational diabetes
  • Gonorrhea screening for women at higher risk
  • Hepatitis B screening for pregnant women at their first prenatal visit
  • Rh Incompatibility screening for all pregnant women and follow-up testing for women at higher risk
  • Syphilis screening
  • Expanded tobacco intervention and counseling for pregnant tobacco users
  • Urinary tract or other infection screening

For All Women:

  • Breast cancer genetic test counseling (BRCA) for women at higher risk
  • Breast cancer mammography screenings every 1 to 2 years for women over 40
  • Breast cancer chemoprevention counseling for women at higher risk
  • Cervical cancer screening for sexually active women
  • Chlamydia infection screening for younger women and women at higher risk
  • Domestic and interpersonal violence screening and counseling
  • Gonorrhea screening for all women at higher risk
  • HIV screening and counseling for sexually active women
  • Human Papillomavirus (HPV) DNA test every 3 years for women with normal cytology results who are 30 or older
  • Osteoporosis screening for women over age 60 depending on risk factors
  • Rh incompatibility screening follow-up testing for women at higher risk
  • Sexually transmitted infections counseling for sexually active women
  • Syphilis screening for women at increased risk
  • Tobacco use screening and interventions
  • Well-woman visits to get recommended services for women under 65

For Children:

  • Alcohol and drug use assessments for adolescents
  • Autism screening for children at 18 and 24 months
  • Behavioral assessments for children ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years
  • Blood pressure screening for children ages: 0 to 11 months, 1 to 4 years , 5 to 10 years, 11 to 14 years, 15 to 17 years
  • Cervical dysplasia screening for sexually active females
  • Depression screening for adolescents
  • Developmental screening for children under age 3
  • Dyslipidemia screening for children at higher risk of lipid disorders ages: 1 to 4 years, 5 to 10 years,11 to 14 years, 15 to 17 years
  • Fluoride chemoprevention supplements for children without fluoride in their water source
  • Gonorrhea preventive medication for the eyes of all newborns
  • Hearing screening for all newborns
  • Height, weight and body mass index (BMI) measurements for children ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years
  • Hematocrit or hemoglobin screening for all children
  • Hemoglobinopathies or sickle cell screening for newborns
  • Hepatitis B screening for adolescents at high risk, including adolescents from countries with 2% or more Hepatitis B prevalence, and U.S.-born adolescents not vaccinated as infants and with at least one parent born in a region with 8% or more Hepatitis B prevalence: 11 – 17 years.
  • HIV screening for adolescents at higher risk
  • Hypothyroidism screening for newborns
  • Immunization vaccines for children from birth to age 18 — doses, recommended ages, and recommended populations vary:
    • Diphtheria, Tetanus, Pertussis (Whooping Cough)
    • Haemophilus influenzae type b
    • Hepatitis A
    • Hepatitis B
    • Human Papillomavirus (PVU)
    • Inactivated Poliovirus
    • Influenza (flu shot)
    • Measles
    • Meningococcal
    • Pneumococcal
    • Rotavirus
    • Varicella (Chickenpox)
  • Iron supplements for children ages 6 to 12 months at risk for anemia
  • Lead screening for children at risk of exposure
  • Medical history for all children throughout development ages: 0 to 11 months, 1 to 4 years , 5 to 10 years , 11 to 14 years , 15 to 17 years
  • Obesity screening and counseling
  • Oral health risk assessment for young children ages: 0 to 11 months, 1 to 4 years, 5 to 10 years
  • Phenylketonuria (PKU) screening for newborns
  • Sexually transmitted infection (STI) prevention counseling and screening for adolescents at higher risk
  • Tuberculin testing for children at higher risk of tuberculosis ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years
  • Vision screening for all children

For more detailed information on these covered tests, check out the Healthcare.gov website!

A look at Lung Cancer: When Prevention is the Only Cure

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Lung Cancer is an unusual disease in that it was once incredibly rare, so much so that many doctors would never see a case in their lifetimes, and is now a leading cause of death almost entirely due to a single, controllable factor – which just happens to be tobacco smoking. It is also one of the most visible diseases, and is relatively well-understood by the public. We know what causes it, we know it is a fatal disease, and there’s not much debate over these points any more.

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Smoking causes lung cancer, and other than a small percentage of cases that arise from industrial and environmental carcinogens, in general exposure to tobacco smoke is the one controllable risk factor for lung cancer. Smokers have ten times the risk of nonsmokers to develop lung cancer, and that’s not including the #2 risk factor, which just happens to be second-hand smoke.

And while there are screening tests for detecting early signs of lung cancer, these tests are limited in ability to help and can carry sizable risks. Screening, while critical in treating some otherwise fatal diseases, cannot keep you safe from lung cancer. In this case, the only realistic solution is abstaining from smoking, or quitting if you already smoke. The earlier you quit, the higher your expected life span and the less likely you are to get cancer, but quitting at any stage of life has a dramatic increase on your life expectancy.

Most people understand the relationship between smoking and lung cancer. They understand that it is an extremely fatal disease that can be prevented in a very straightforward manner, even if it may be hard to do so. But it’s important to also look at the big picture with regards to prevention as a means of achieving better health and preventing fatal diseases.

There are many diseases where prevention, before the fact, is the most reasonable “cure”.  Type 2 Diabetes, for example, can be prevented in many people by exercising, avoiding obesity, and eating in a healthy manner. While there are treatments and techniques for managing the disease once it has been acquired, the only safe option is not developing it in the first place! Even better, these same lifestyle choices can help prevent Heart Disease and Strokes, which are among the most deadly and frequent killers of Americans.  Cervical Cancer is one of many diseases that can be largely prevented with proper vaccination at an early age. Esophagal Cancer can be prevented by proper treatment of chronic acid reflux disease before it develops into something more.

Remember, you have the ability to manage your own health better than any doctor can. You might not be a medical professional, but you control what goes into your body, when you exercise, and how often you visit the doctor’s office. You have a great deal of power. It’s important to take your role of caretaker of your body seriously!

When Screening Might be a Mistake: Prostate Cancer

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Prostate Cancer is the most common internal organ malignancy in men in the United States. Every year, over 30,000 men die from complications of prostate cancer,  making it the second leading cause of cancer death after lung cancer in men. All signs point to it being one of the most important cancers for doctors to discuss with their patients and to catch early.

And yet the American Cancer Society (ACS) and the United States Preventive Services Task Force (USPSTF) do not recommend routine blood testing for prostate cancer screening – even though it is effective at detecting cancer early. Why would these groups not recommend screening, in that case? It would seem to be a “common-sense” issue to most patients that an early catch equals an early cure. However, with prostate cancer, the situation is much more complicated.

An early American study published recently found that annual use of blood testing and digital exams (where a doctor physically searches for abnormalities with a finger) detected prostate cancer early, but did not lower the death rate from this malignancy. And while a recent large, well-structured study from Europe found a small benefit of blood testing, on the other hand a preliminary result of a large prostate cancer screening trial published in the New England Journal of Medicine in March 2009 showed no survival benefit from screening.

What this means is that while we don’t have much evidence that catching early prostate cancer allows us to do much about it. Furthermore, there is controversy over whether screening in older men, who might die other natural causes before the cancer took its toll, is actually improving quality of lives or simply encouraging them to undergo difficult treatment that is unlikely to extend their lifespan.

Most doctors still believe that catching early prostate cancer can save lives, and most will tell patients this if asked. Nearly every health organization recommends discussing screening options with your doctor, and knowing the warning signs of prostate cancer in order to make better decisions. But this controversy serves as a reminder that screening, even when it is effective at detecting a disease, is not always the answer for finding a cure.

Adult Vaccine Guide: What you need, and when

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Adult vaccines are just as important as childhood vaccines – the tough part is, you have to remember to get them! Hopefully, this simple chart can help out the next time you schedule a check-up. Remember, it’s on you to keep your doctor up-to-date with your vaccine history!

adultvaccines

These reminders are for average-risk people only! If you have contraindications, or pre-existing conditions, or are high-risk for certain diseases, you will need to speak to your doctor and will probably be on a very different vaccination schedule. In these cases, it is extremely important that you and your doctor work together to make sure that you are taking the right vaccines at the right times, as your health depends on it.

I hate being sick: The Fundamentals of Preventive Medicine

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Getting sick is awful. Even a common cold can ruin your week; being laid low for a single day still leaves you sluggish and tired, sets you behind on work, and can easily snowball into a weekend of stress and helpless catch-up. More serious illnesses are obviously even worse – from a lengthy sinus infection all the way up to life-threatening illnesses and afflictions.

Our society has traditionally focused on Reactive Medicine – curing and treating diseases after they are detected. But with every passing year, more and more attention is paid to Preventive Medicine – preventing illnesses before they occur through early detection and healthy living. The argument for preventive medicine is simple and convincing: preventing diseases is often cheaper and more effective than treating them. In many cases, prevention is the only option for diseases that are otherwise fatal! The good news is that you obviously can’t die of a disease you never get.

Prevention seems simple on the surface, but there are many factors that go into it.  Most of us receive vaccines as children and adults, and perform common preventive techniques such as washing our hands, trying to eat healthy, and avoiding dangerous carcinogens such as tobacco smoke. This is known as primary prevention: preventing diseases before they actually occur. When a doctor takes your blood pressure and makes recommendations for keeping it under control, he or she is practicing primary prevention.

Most people are familiar with common screening tools such as blood tests, Pap smears, x-rays, and other medical exams designed to detect the early signs of diseases. This is known as secondary prevention. By detecting diseases at an early stage before symptoms have begun, doctors can treat these illnesses more effectively and with much higher rates of success. A disease that is detected early may have close to a 100% 5-year survival rate, meaning people who have the disease treated during this early stage tend to live a normal life span. The very same disease detected late may have a dismal 15% or less 5-year survival rate if detected during the late stages, meaning most people who are diagnosed late will likely die within 5 years.

The final piece of the puzzle is called tertiary prevention. This involves preventing the adverse effects, including the recurrence and complications, of existing diseases. A simple example is the use of aspirin to prevent heart attacks and congestive heart failure in patients who already have coronary heart disease. Another example is the use of the drug tamoxifen to help prevent the spread or recurrence in patients with history of breast cancer.

So when is preventive medicine most effective? The answer boils down to risk, cost, and potential complications.

The patient and doctor must always ask themselves: What are the risk factors for the patient that make this disease likely and worth screening for? In many cases, a disease is more likely based on family history, sex, or lifestyle factors. In these cases, certain tests should be considered and certain preventive techniques should be undertaken. In other cases, a patient is at such low risk for certain illnesses that screening is more likely to result in a false positive test or undue hardship than to provide a benefit, and should be viewed with skepticism.

The cost of screening and prevention often goes hand in hand with the risk factors. One of the goals of preventive medicine is to reduce the overall cost in healthcare, and in many cases it is significantly cheaper to prevent diseases than to treat them reactively. However, this is not always the case, especially when considering the countless number of potential tests and procedures that exist to detect illnesses. It is important to weight the benefits of a test against the likelihood of the patient actually being at risk, as excessive testing can create unnecessary financial burden. The good news is that while screening can be expensive, many preventive measures can be taken by the patients themselves cheaply or free of cost. It costs nothing to avoid smoking, to avoid excessive sugar and alcohol, and to exercise daily, for example.

Finally, the potential complications of any preventive procedure must be considered. Some procedures are invasive or stressful, and in many cases false positives can lead to additional stress, invasive follow-up procedures, and time/money lost. It is important to focus on procedures that are most likely to contribute toward a long and healthy life without causing undue hardship.

It’s important to discuss all these factors with your doctor, as well as to research them for yourself. In a future post, I’ll be detailing some of the most common preventive tools and the ages you should start scheduling certain procedures with your doctor. Preventive medicine is often the best tool for staying healthy – but it requires you to know your body and your options better than ever!