Know the Difference Between a Preventive and Diagnostic Screening

Posted on Jul 5th 2019 by Florida Blue

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Have you heard that there are different kinds of care you can receive? Preventive and diagnostic screenings are two ways your doctor helps keep you healthy. Understanding the difference between the two might seem minor, but it’s a small detail that will help explain reasons you might need some care over others. So, what’s the difference?

Preventive care is given when you are symptom-free and have no reason to believe that you are unhealthy. Your doctor will recommend you get certain preventive tests every year to keep you healthy. If you’re a Florida Blue Medicare Advantage health plan member, you may earn rewards for completing certain preventive tests. Learn more here.

When you already have symptoms or risk factors, your doctor may use diagnostic tests to find and treat the problem. If your doctor spots anything abnormal during your preventive screening, they may order diagnostic tests. Diagnostic care can also include X-rays and lab tests, like blood work.

There’s another big difference between preventive and diagnostic screenings: How much you pay out of pocket. Your Florida Blue Medicare health plan includes many preventive screenings at no extra cost to you when you use an in-network provider. We cover diagnostic screenings too. However, these usually have a copay or coinsurance you’ll have to pay.

Read more about these common health screenings to find out when they can turn from preventive care to diagnostic care. Always feel free to ask the staff at your doctor’s office about the difference.

Colorectal Cancer Screening:

  • When it’s preventive: A colorectal cancer screening is a routine test that checks for early signs of cancer. There are different types of preventive colon cancer screenings, such as a FIT (fecal immunochemical test) kit, Cologuard® (FIT-DNA), or a colonoscopy. Your doctor will tell you which test is right for you. Look in your Evidence of Coverage (EOC) to see how we cover these tests. Log in to your member account at and click on “Forms & Resources” to find your EOC.
  • When it’s diagnostic: If your preventive colon cancer screening results show something abnormal, or if you’ve been having rectal bleeding, your doctor will want to find out why. If you used a FIT kit or Cologuard test, your doctor may order a colonoscopy for you. Or if your doctor finds an abnormal growth, like a polyp, during your preventive colonoscopy, they’ll often remove it and test it for cancer. You may have a copay or coinsurance for the lab tests.

Breast Cancer Screening:

  • When it’s preventive: You get a mammogram to check for breast cancer. You should get screenings every one or two years, depending on your doctor’s advice. Your Florida Blue Medicare health plan includes a mammogram screening every year for women age 40 and over. This screening is no cost to you.
  • When it’s diagnostic: If your doctor notices a lump or anything unusual on your breast, they may ask you to do further testing to determine the cause and rule out cancer.

Diabetes Screening:

  • When it’s preventive: A blood glucose test is used to check for abnormalities in your blood sugar levels. Even though you might not have symptoms, you could still be at risk. Other preventive screenings for diabetes include checking your urine for protein and getting a retinal eye exam.
  • When it’s diagnostic: If you have diabetes, your doctor will use an A1C blood test to check and track your blood sugar levels.

Blood Pressure Test:

  • When it’s preventive: If you have no history of high blood pressure, your doctor will do a routine blood pressure test at your annual visit.
  • When it’s diagnostic: Are you having frequent headaches or shortness of breath? Do you use tobacco or weigh more than you should? Your doctor may run additional tests to see if you have high blood pressure.

Bone Mineral Density Test:

  • When it’s preventive: If you break a bone, your doctor will likely order a bone mineral density test for you within six months. In this case, a bone mineral density test is preventive because it tests your bone strength.
  • When it’s diagnostic: If your doctor thinks your bones are too weak, they may prescribe medication that helps build up your bone strength. You’ll likely need a follow-up bone mineral density test to see if the medication has made your bones stronger.

Check your HealthyBlue Rewards and Loyalty dashboard to see which preventive screenings earn you rewards. Once you complete an eligible screening, be sure to report it and claim your rewards.







Y0011_96455_C 0619 C: 06/2019



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