The latest big push in health care is keeping you from getting sick in the first place. Insurers are sending you reminders to schedule regular exams. Employers are rewarding workers who quit smoking or lose weight. And a key provision in the Affordable Care Act, a.k.a. Obamacare, is full coverage for certain preventive care—with no out-of-pocket costs for you.
Getting a handful of basic tests every year can reap rich rewards. “So many diseases, such as hypertension and diabetes, are symptomless in the early stages, when they can be easily caught and controlled,” says Dr. Nieca Goldberg, director of the NYU Women’s Heart Center. So see your primary-care doctor annually once you reach your forties (until then, every two or three years is usually sufficient).
Even though fully covered tests are getting more common, for many others you will face co-pays or co-insurance—and shoulder the full cost until you reach your deductible. To keep those costs to a minimum, we recommend two strategies.
First, look for ways to save on every test you take. Prices can vary widely for the same service, even when you stick with in-network doctors and facilities.
Start by checking your health insurer’s website—many list doctors that insurers believe offer quality care at fair prices. Keep in mind that MRIs, CT scans, and other imaging tests often cost much less at freestanding radiology centers. (Just be sure the facility is accredited by the American College of Radiology and that your doc will accept the results.) And when your doctor orders a blood test, ask about all your options, including outside the office. “Labs are so standardized, a $10 lipid panel will get the same results and same quality as a $200 lipid panel,” says Scott Matthews of Castlight Health, which helps big businesses manage their health care costs.
Second, learn which screenings are worth your health care dollars and which you can skip. Here’s what you need to know:
6 Essential Tests for Everyone
1) Skin exam
With skin cancer on the rise, it’s smart to have a dermatologist examine the skin over your entire body, looking for suspicious growths, moles, and lesions.
When to get it: At least once a year. “If you have risk factors, such as being fair, having a lot of moles, or having a family history of skin cancer, you may need to be seen as often as every three to six months,” says Dr. David Leffell, chief of dermatologic surgery at the Yale School of Medicine. You could go to your primary-care doctor, but dermatologists are better at diagnosing potentially cancerous lesions, studies show.
Cost: $50 to $150. Insurance covers the visit after you meet your deductible; your usual co-pay or co-insurance will apply.
2) Cholesterol check
This blood test, a.k.a. a lipid panel or profile, reports your total cholesterol, your LDL (“bad”) cholesterol, your HDL (“good”) cholesterol, and a type of fat in the blood called triglycerides. High levels of all but the good stuff raise your risk of heart disease and stroke.
When to get it: Men over 45 and women over 50 should be checked every one to three years, says Goldberg. (Until menopause, women have the protective benefits of estrogen.) At younger ages, test every four to six years. Among the reasons for more frequent screenings: Your results aren’t normal, there’s a family history of heart disease, or you have risk factors like being overweight, you smoke, or you have high blood pressure.
Cost: $110 to $305 for test alone. Cholesterol testing is often included in an annual physical, which insurance covers in full.
3) Blood-pressure check
High blood pressure raises your risk of heart disease, stroke, kidney failure, and other serious conditions.
When to get it: Every two years as part of a routine physical; once a year or more if your pressure is above 120/80.
Cost: $70 to $200 for a doctor’s visit, but insurance pays the full tab for your annual preventive checkups
4) Eye exam
Even if you think your vision is 20/20, have your eyes examined regularly—especially after 40. As you age, you’re at risk for conditions such as glaucoma, which is symptomless. “An exam can also find signs of another disease that may be affecting your eyes, such as diabetes or high blood pressure,” says Dr. Rebecca Taylor, an ophthalmologist in Nashville and a spokesperson for the American Academy of Ophthalmology.
When to get it: Before age 40, Taylor suggests getting a full exam with an optometrist or ophthalmologist every five to 10 years (yearly if you wear glasses or contacts). After that, make it every two years. Reasons to get more frequent exams include a family history of eye disease, previous eye injuries or surgery, diabetes or high blood pressure, or you are over 65.
Cost: $75 to $200 with an ophthalmologist; $50 to $150 with an optometrist. Insurance coverage varies.
5) A1C blood test
This has become the screening test of choice for diabetes, as it measures your average blood glucose over roughly three months; the fasting blood glucose test tells doctors just what your level is at that moment.
When to get it: The standard recommendation is every three years starting at 45. The American Diabetes Association advises beginning earlier if you’re overweight and have certain risk factors, including high blood pressure.
Cost: $40 to $260 for test. If you have high blood pressure, insurance covers in full.
This exam is your best defense against colon cancer. While there are other screening tools, a colonoscopy is considered the gold standard: “It doesn’t just diagnose; if the doctor sees adenomas [potentially precancerous polyps], he can remove them then and there,” says Dr. Seth Gross, director of endoscopy at Tisch Hospital at NYU Langone Medical Center.
When to get it: Start at age 50, earlier if you’ve got other risk factors, such as a family history or if you have suspicious symptoms. If the test is negative, get one every 10 years.
Cost: $1,100 to $2,800. Insurance pays every 10 years for adults ages 50 to 75.
4 Essential Tests for Women
Insurance will cover the basic pelvic and breast exams that are part of your annual visit to a gynecologist. Other tests aren’t needed as often—and your insurance coverage will probably reflect that.
1) Pap smear
A Pap smear, also called a Pap test, is when your gynecologist collects cells from your cervix to screen for precancerous changes. Thanks to this test, the cervical cancer death rate declined by almost 70% between 1955 and 1992, according to the American Cancer Society (ACS).
When to get it: Every three years, provided your last test was normal; most women can stop at age 65.
Cost: $75 to $350. Insurance pays in full every three years from ages 21 to 65.
There’s been controversy in recent years about when to begin breast cancer screening and how often to do it, but the American Cancer Society and American College of Obstetricians and Gynecologists still recommend getting your first mammogram, an X-ray of your breasts, at 40— earlier if you have risk factors like a family history. Ask your doctor about 3-D mammography, now available at some major medical centers: It reduces false positives and slightly bumps up detection rates, according to a recent JAMA study.
When to get it: Once a year starting at age 40.
Cost: $150 to $375. Screening is covered every one to two years at age 40-plus. Most plans don’t cover more precise 3-D mammograms, so you may owe $40 to $60.
3) DEXA scan for bone density
An X-ray test to measure bone density, this screening is recommended for all women at age 65. But you may want to get one around menopause, when declining estrogen levels increase your risk of osteoporosis.
When to get it: Start at age 65, then consult doctor. With risk factors like smoking and osteoporosis in family, begin at menopause.
Cost: $60 to $385. Insurance pays in full when 65-plus; with preapproval, it often pays for younger postmenopausal women too.
4) HPV (Human – papilloma- virus) test
Typically done at the same time as a Pap, this checks for strains of HPV that are most likely to cause cervical cancer. Before age 30, nearly all sexually active people contract HPV at some point, according to the Centers for Disease Control. Most of the time, HPV is harmless and clears up on its own. But since HPV infection is less common in women over 30, a positive test result is more apt to signal a potential problem.
When to get it: Women ages 30 to 65 should get an HPV test paired with a Pap smear every five years.
Cost: $30 to $125. Insurance pays in full every five years from 30 to 65.
6 Tests You May Need
1) Vitamin D test
Vitamin D helps you absorb calcium and maintain strong bones. Since up to 75% of Americans have low levels (a 2009 study suggests), ask your doctor about adding this to your physical, advises Dr. Marianne Legato, professor emeritus of clinical medicine at Columbia University Medical Center.
Cost: $25 to $150; some, but not all, insurers cover
2) Thyroid-stimulating hormone test
Experts disagree about whether routine thyroid screening is necessary, but make sure to get your blood level of TSH checked if you have fatigue and unexplained weight gain.
Cost: $15 to $115; often covered. Deductible and co-pay or co-insurance apply.
3) Cholesterol particle tests
People whose particles of LDL cholesterol are mostly small and dense have a threefold greater risk of coronary heart disease. Ask your doctor about this test if your cholesterol is borderline, especially if you’re debating whether to go on cholesterol-lowering medications, Goldberg says.
Cost: $15 to $265; not usually covered for routine screening but may be covered in part if you have risk factors.
4) Coronary calcium scan
A CT scan of your heart is used to look for specks of calcium in your arteries that may indicate early signs of coronary artery disease. While this scan is not recommended for everyone, it can be useful if you’ve got a family history or other risk factors. “A score greater than 300 tells us that you’re at increased risk of cardiovascular events in the next five to 10 years,” Goldberg says.
Another heart exam—an exercise stress test—isn’t a useful screening tool if you’re low risk, she adds, due to a high rate of false positives. As a rule, it’s best reserved for people who have risk factors or symptoms such as chest pain or an irregular heartbeat.
Cost: $10 to $300; not usually covered for routine screening, but may be covered in part if you have risk factors.
5) CRP (C-reactive protein) test
This measures blood levels of CRP, an inflammatory protein associated with heart disease. It’s most predictive in men over 50 and women over 60, Goldberg says. In a 2010 study, people in these age groups who were at intermediate risk of heart disease and who had normal cholesterol but high CRP levels benefited from going on cholesterol-lowering medications.
Cost: $10 to $115; not usually covered for healthy patients but often covered in part if you have risk factors.
6) Prostate exam
Screening for prostate cancer used to be a must. Now it’s a maybe. “Intuitively, it makes sense to treat prostate cancers early,” says Dr. Richard Wender, chief cancer control officer at the American Cancer Society. “But some grow so slowly that they’d probably never be life-threatening, and the treatment would be worse for quality of life than the disease itself.” That said, a study published in The New England Journal of Medicine this past March found that men under age 65 who underwent surgery for early-stage prostate cancer (instead of watchful waiting) had better survival rates.
Bottom line: At 50, talk to your doctor about your risks (like a family history). If you decide to undergo a PSA (prostate-specific antigen) blood test and it’s under 2.5 ng/mL, you can wait at least another two years to retest. If it’s over that, test annually.
Cost: $25 to $125 and may be covered by insurance for men older than 50, or starting at age 40 if you face certain risk factors.