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It’s that time of year again. Forget turkey and pie, we’re taking about the uptick of mustachioed men everywhere you look can mean only one thing: Movember is upon us. Also, No-Shave November and Novembeard– take your pick! But it’s not just about scruffy faces and furry upper lips. When you consider that, on average, men die six years earlier than women worldwide, these organizations’ act of raising awareness about men’s health seems especially urgent. 

Luckily, with good insurance, there’s a lot men can do, year-round, to stay healthy and shift those daunting statistics. Specifically, each year, the Affordable Care Act entitles all men to one free wellness visit. The cost is covered by most insurance companies (among them, Oscar), whether or not annual deductibles have been met. Here’s how it works, and how to get the most benefit out of the experience. 

Each year, the Affordable Care Act entitles all men to one free wellness visit. The cost is covered by most insurance companies (among them, Oscar), whether or not annual deductibles have been met. Yes, this is a great benefit, but it helps to know how it works, and how you can get the most out of the experience.

What is a men’s wellness visit?

The goal of the men’s wellness visit is to develop a personalized prevention plan—helping you identify and deal with any factors that can put your health at risk. For this reason, the checkup generally takes place separately from other appointments. Broadly, here’s what a typical encounter might involve:

  • Documenting your health habits and reviewing your family history:When you arrive for your visit, your doctor or nurse practitioner will ask some questions about your overall health in order to identify risk factors. These questions may cover topics like your medical history, family health history, medication history, sexual health, mental health, eating habits, physical activity, and drug use. Medical professionals are required to keep a patient’s personal health information private, so you can discuss these and any other health concerns to the degree that you feel comfortable.

  • Providing a physical exam, ordering tests and other services: This generally includes specific exams, lab tests, and sometimes immunizations, all in order to prevent diseases or catch them early, when they may be easier to treat.

  • Helping you to set health goals: You and your provider also have the opportunity to talk about the next steps for helping you stay healthy. That may involve counseling to support you in making informed decisions about diet, medication, exercise, stress management, and more. Together, the two of you can also review and decide which screenings or follow-up services might be right for you.

What, specifically, is covered?

For your wellness appointment to qualify for free coverage, it must take place with a doctor (most often a specialist or a primary care physician) or nurse practitioner who’s in your network. Ideally, this should also be someone whom you trust, whom you’d like to continue to visit, and who can help you to coordinate your care among other clinicians you may need. (If you’re an Oscar member, you can connect with an in-network provider here.)

Health education and screening tests are among the most important things you can do for your overall wellness, so take advantage of those that make sense for you. For the former, counseling is based on your age, family history, and lifestyle risk factors. As for screenings, try out this link to see which would be recommended for you, based on your age, use of tobacco, and whether you are sexually active.

You and your provider can also decide on some additional services, including immunizations. Many are available at no cost to you if they are recommended by the US Preventive Services Task Force (USPSTF) and given a grade of A or B (which signals that the benefits outweigh any risks), or if they are immunizations recommended by the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP).

To give you a sense of what you might expect, here’s a short list of some of the most common core services. You’re probably familiar with most of them, and all are typically covered by all Marketplace plans, like Oscar.

Sometimes, your provider will want to do further tests that aren’t covered as free preventive services. For example, if you are a diabetic, he or she may want to order a blood test to check on your diabetes. Because you already know you have diabetes, the test isn’t considered preventive and would therefore incur a cost. If you’re concerned about costs, or just want to keep track and avoid surprises, refer to the USPSTF and ACIP links above, or ask your provider to specify which among the tests he or she suggests might not qualify for men’s wellness visit coverage. (For Oscar users considering services that don’t meet the coverage criteria, remember that you can see how close you’ve come to your deductible at the top of your member page and you can always call or email us with questions or further support.)  

How can I optimize my visit?

Wellness appointments can offer an incredible opportunity to get information, set goals, and plan ahead. To make sure you don’t forget something important when you’re on the spot, write down ahead of time your medications and doses, major medical events including surgeries and immunizations, and any medical conditions and concerns. (If you’re an Oscar member, you can also print out and bring along your Health Timeline, which keeps track of your recent medical history.)

Likewise, because your family’s health history can help your provider determine your risk factors, bring a list of which close relatives have had cancer, heart disease, and other serious health problems. The Surgeon General’s office has even generated an easy-to-use tool where you can save all the information for easy access.

Lastly, come with questions and be ready to take notes. Much of the value of these visits can come from gathering knowledge from your doctor or nurse, and talking about the next steps that you can take to stay healthy and meet your personal wellness goals.

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A men’s wellness visit is intended to keep you healthy, and Oscar is here to help. If you need assistance finding a doctor, or if you have any questions, please just give us a call at 855-OSCAR-55 or email help@hioscar.com. We’ll be happy to give you all the info you need. Also, between office visits and for quick health questions, our Doctor on Call service lets you talk to a doctor any time of the day.