Stay healthy, save money, run the world: A ladies’ health care cheat sheet | hioscar Blog | Oscar
Stay healthy, save money, run the world: A ladies’ healthcare cheat sheet
Take advantage of free OB-GYN services – and learn what you may have to pay for out-of-pocket.
Women's HealthClinically Speaking
6 min read
Share article
There’s no denying, it costs a lot to be a woman.
From managing our monthly cycles to birth control to fun little OB-GYN emergencies, there are a lot of extra things we ladies have to consider when it comes to our health care costs. And all those things can leave us with stacks of expensive, unanticipated medical bills.
Fortunately, Oscar offers a number of free services to help women stay healthy throughout the year, including an annual well-woman exam, maternity benefits, birth control options, and routine cervical cancer and breast cancer screenings.
During your well-woman exam, you and your doctor will discuss your health history so they can determine your susceptibility to certain health conditions that may run in your family. You’ll also receive a gynecological examination, which includes a cervical cancer screening (aka pap smear) and a breast exam.
Additionally, your doctor will offer you counseling on sexually transmitted infections (STIs) and birth control options. Lab work for most common STIs is also included during your well-woman exam, as long as it’s processed at an in-network lab (see next section).
2. Take advantage of free screenings.
Well-woman exams include free preventive lab testing. Tests covered during your well-woman exam include:
Breast Cancer Genetic Testing (BRCA), for some women at higher risk for breast cancer
Cholesterol screening (lipid panel)
Cervical cancer screening (pap smear), for women 21 and over or for women with certain risk factors
Chlamydia screening
Diabetes (Type 2) screening, for adults with high blood pressure
Gonorrhea screening
Hepatitis C screening, for those at higher risk
HIV screening
Human Papillomavirus (HPV DNA) test
Syphilis screening
Occasionally, your doctor may recommend you be tested for other issues such as yeast infections or bacterial infections at the time of your visit. These tests are considered diagnostic, which means you may be responsible for some of the cost.
3. Use an in-network lab.
Whether you’re getting preventive or diagnostic tests, it’s important to remember that not all laboratories participate with your health plan. Oscar’s preferred labs are Quest Diagnostics, BioReference, and LabCorp which means your preventive labs will be free only if they’re processed at these labs in your state. Make sure to ask your doctor to have all labs processed at that location during your appointment to avoid getting charged for an out-of-network lab.
4. To pap or not to pap, that is the question.
Over the years, federal guidelines for pap smears (opens in new tab) have shifted. While your insurance plan covers one of these screenings each year during your annual well-woman exam, the USPSTF recommends that women ages 21 - 65 get a pap every three years. Women between 30 - 65 can lengthen that interval if they receive cervical cancer testing in tandem with HPV testing (HPV can lead to cervical cancer). Your doctor will help you determine how frequently you should receive each of these screenings based on your family history and past test results.
On occasion, follow-up testing is required for women who receive irregular pap results, which are not uncommon. These tests are diagnostic and do not fall under the federal guidelines of preventive care, which means you may be on the hook for a portion of their cost. If your doctor recommends you receive a test like a colopscopy (opens in new tab) to confirm the results of an irregular pap smear, check your plan benefits in your Oscar account (or ask your Concierge team) to see what your cost share might be.
5. Protect your assets.
After you receive a manual breast exam during your well-woman exam, your doctor may decide you need additional testing like a mammogram, breast ultrasound, or 3D mammogram. Certain factors like your age or health history may make you a candidate these types of breast imaging services, which can help detect breast cancer early. Many women are eligible for free preventive breast imaging services, but you’ll want to check first with your Concierge team to make sure you meet those guidelines.
6. Get poked.
Your well-woman exam is a great time to catch up on any outdated shots. Ask your doctor if you’re due for any of the following vaccinations, which are free when you get them during your well-woman exam or an annual physical with your primary care doctor.
Influenza (flu shot)
Tdap (tetanus, diphtheria and pertussis aka whooping cough)
Td (tetanus and diphtheria)
Varicella (chicken pox)
HPV (human papillomavirus)
Zoster (shingles)
MMR (measles, mumps, and rubella)
Pneumococcal (PCV13, PPSV23, or pneumonia)
Meningococcal (meningitis) (Only A, C, and Y are considered preventive, not B.)
Hepatitis A (Hep A)
Hepatitis B (Hep B)
Hib (Haemophilus influenzae type B)
While most doctors stock vaccinations at their office, you may need to fill a prescription for one before your appointment. Call your doctor’s office ahead of time to see if they carry the shots you need. If you have any questions about where to get a vaccination Rx filled, check in with your Concierge team, and they can help you.
7. Ask for generic birth control.
Why pay for something when you could get it for free? Many types of birth control are fully covered by your health insurance plan. Just keep in mind that not all forms are covered by your plan.
Search Oscar’s formulary (opens in new tab) to see how your birth control is covered. If you’re using a brand name Rx that isn’t covered, ask your doctor about switching to the generic version to save money.
8. Get an IUD on the house.
Certain types of IUDs (intrauterine devices) are covered by your health insurance plan as a free preventive benefit. IUDs are a semi-permanent birth control option and last between three to seven years. They come in two forms: plastic, which contains hormones that allow the device to be inserted for up to five years; and non-hormonal copper, which produces an inflammatory reaction in your uterus, allowing the device to be inserted for up to 10 years.
IUD insertions can be performed at your OB-GYN’s office during your well-woman exam or a separate office visit. In both instances, the cost of the device and the insertion will be covered by your plan, as long as you use an IUD that’s covered.
Many OB-GYN offices carry IUDs in house, so check with your doctor before your appointment to make sure the devices they carry are covered by your health plan. If your OB-GYN’s office doesn’t carry IUDs, you may be able to fill an Rx for the device through our Mail Order Prescription Program or at your local in-network pharmacy.
IUDs occasionally cause complications such as gynecological infections. Any care you receive to treat these conditions is diagnostic and will be subject to cost-sharing per your benefits.
Got a bun in the oven?
In addition to preventive well-woman benefits, Oscar also provides pregnancy preventive benefits. Some pregnancy benefits are covered-in-full (opens in new tab) by your insurance plan, and others are subject to cost-sharing.
Pregnancy preventive benefits vary from state-to-state, but generally include:
Office visits.
Lab services like STI testing.
Anemia, tobacco, asymptomatic bacteriuria, and blood typing screenings.
Sonograms are typically subject to cost-sharing, and there may be a limit to the number of tests Oscar will cover. Lamaze, lactation counseling, genetic testing and breast pumps are also benefits that will be partially or fully covered by Oscar, depending on the state you live in.
If you have any questions about your OB-GYN benefits, check out the Benefits section (opens in new tab) of your online account. You can also give your Concierge team a call (1-855-672-2755), and they’ll be happy to review with you.
