Episode 84 – Free preventative care for PEBB and SEBB members
Taking care of your health might be one of the smartest financial moves you can make. In this episode, we talk with Heather from the Washington State Health Care Authority (HCA) about preventive screenings and care available to employees enrolled in PEBB and SEBB plans. Many services including well visits, immunizations, mammograms, and colorectal cancer screenings have no out of pocket cost. We discuss when screenings are recommended as you get older and why some important ones are often forgotten.
Episode transcript:
[music intro]
Jenny
Welcome back to Fund Your Future with DRS. So, there’s a famous quote from a baseball legend, Mickey Mantle, where he once said, “if I knew I was going to live this long, I would of taking better care of myself.” And that’s certainly true for a lot of people. And on the podcast we’ve talked a lot about financial health and preparing for retirement, but today we wanted to take a deeper dive into what kind of preventative steps you can take to maintain your physical health, as that is just as important as the financial piece.
So, we are happy to be joined by Heather from the Washington State Health Care Authority, where she serves as the medical director for the PEBB and SEBB employees and retirees’ benefits. So welcome, Heather.
Heather
Thanks for having me.
Seth
This was a request from a listener. And I think for a lot of us who are younger, oftentimes we don’t take full advantage of our medical benefits. And I know oftentimes as a man in my 20s and 30s, people would ask me who my primary care provider was, and I would say, I don’t have one of those or I don’t know.
I don’t know what you mean by that question. And so, we want to try to help maybe break that stigma a little bit and talk about what services people should be thinking about every year or however frequently they’re recommended. So, we’re hoping you could just start off by giving us a few examples of preventative screenings or care that are generally available to people who are in the PEBB and SEBB programs.
Heather
Yeah, happy to do so. I think an important thing to remember for PEBB and SEBB members and their coverage is that preventive care services are at no out-of-pocket costs to members. So that’s before even your deductible is met. When there are services that are preventive, whether they are screenings or exams, all of those are covered with no cost to the PEBB and SEBB member.
And preventive care and screenings occur throughout the entire lifespan. So, on the young end of things, think of newborn exams, well-child exams and then continuing through that, childhood exams. The frequency of those depends on the age of the child. Annual exams are covered for adults as well and that is another area where talking with your primary care provider to determine what the best frequency of how often you need to come in for those visits.
For some people, that will be annual, for others less so. And then vaccines. Vaccines are preventive care that you can get with no out-of-pocket cost. And you should talk with your provider to know what vaccines you are due for and appropriate based on your age. And then cancer screenings are another one that are important preventive care that folks should get.
The two big ones that come to mind are mammograms and colorectal cancer screening.
Jenny
Yeah. And then are there certain sort of ages that people should think about these particular screenings, like, what are some of those big milestones that maybe starting when you’re 18, that you should be thinking about as you get older?
Heather
Yeah. So, I think for the younger adult population, vision screening is important. And that also is going to depend based on your individual risk factors, how frequent you need those. So that’s something that’s good to talk with your primary care provider about. For things like cancer screenings, those typically start, if there aren’t additional risk factors that an individual has in midlife, and the starting screening age is actually starts to drop for both mammograms and colorectal cancer screening.
So that age 40 is the youngest age that that’s recommended for someone at typical risk. But again, I would always recommend that, individuals talk with their primary care provider to assess their individual risk and know when the appropriate age to start those screenings would be.
Jenny
Yeah. For sure. I had started to hear that recently as a person who’s in my 40s, and so I was thinking about that recently. I was like, “oh my gosh, I need to get this. I need to get a mammogram scheduled.” Go through that fun process of getting older.
Seth
Yeah, I had a similar experience with, well, actually two things, but I’ve always had really great vision. And then as I’ve gotten into my mid 40s, realizing like, “oh, getting an annual vision test is a normal thing to do.” And I was having trouble reading the crossword puzzle and realizing like, “oh, this is something that”…. I see Heather’s laughing and like, this is a normal thing that people go through.
But you oftentimes these like age criteria’s don’t kick in. And I just recently turned into my mid 40s and had my first colonoscopy and it was like not as unpleasant as people make it out to be. And I think that’s one of the things I wanted to share as a takeaway, like oftentimes in a similar way that when we talk about retirement stuff, it’s scary because it reminds you of death.
And I think the things that can go wrong in these screenings or that, like the possible negative results you get, can maybe make you not want to do it. Heather, I was wondering if you just want to talk a little bit about if there are screenings that people are more likely to skip or things that can be really successful at identifying things if you catch them early, it can be better for your long-term health.
Heather
Yeah. So, I think colorectal cancer screening is a perfect example of both a screening that people are often hesitant to do, both because of the procedure itself and the preparation for the procedure. And as you describe some of the anxiety around, what might be found when that screening happens. But colorectal cancer screening is an excellent example of an area where we know when we catch cancers early that outcomes are improved, and in some cases, for colorectal cancer screening, you’re catching not even cancer, but what we call precancerous lesions.
So, things that over time, if left to remain in the colon, could turn into cancer, but could easily be addressed during the colonoscopy itself to remove those precancerous lesions. I think another option that people don’t realize for colorectal cancer screening is that there are stool tests now that are also quite effective at screening for colorectal cancer. The difference between the stool screening is that those are done every year.
Where the benefit of the colonoscopy is, it is a bigger process to have that procedure done. But then you’re good for a ten-year period.
Jenny
And I’ve kind of heard some different things about, yeah. Do you see the commercials for, you know, these, you know, send in a sample through the mail to these particular companies.
Heather
Some people call them FIT kits. Some people also call it by the brand name. There’s a particular brand name, but we think of those as not just the brand name, but because there are different, different stool testing kits that are out there. And those can be done through your primary care providers office, and those can often be mailed back as well.
You can go to your provider, they give you the kit, they give you the instructions, and then you can put it in the mail and it goes back to the clinic.
Jenny
Oh, perfect. And it sounds like obviously the colonoscopy is preferred because it does give you more information.
Heather
I would say that the recommendations are that either are an appropriate screening tool when used appropriately. So, if you have a stool screening test, you may be then referred for a colonoscopy. So, if you have a stool colorectal cancer screening test that is negative, then you are good for the next year and you don’t need to do anything else.
But they are sometimes. But I guess I would describe as false positives. So, the way that you would confirm a positive result on the stool screening would be to have a colonoscopy. So sometimes folks end up with two steps. Whereas when you do the colonoscopy right out of the gate, you’re done for a decade.
But each method of screening is an effective method for screening, just different preference about whether you want to have a procedure, whether you want to do the stool test, and then the frequency of the screening that’s required for ten years versus every year.
Jenny
Perfect. Okay. Thanks for clarifying that. Yeah.
Seth
I know the other thing I think about with our insurance benefits is that there’s oftentimes, I guess, care or services that can be encouraged to help improve our health outcomes as well. I think of like helping people stop smoking or diabetes treatments. Are there other things like that, or do you want to expand on some of those things that might be preventive care?
They might not fall into the example that you were mentioned about, where there’s no out-of-pocket costs, there might be out-of-pocket costs associated with some of these things, but that they are, in a lot of ways, what I think of as preventative. I’m not sure if that’s a fair medical way to describe it. But yeah.
Heather
I think if these types of preventative care as situations in which someone has either a diagnosis or a habit, something that they are doing, like smoking, where you are trying to improve that person’s health. So, there is a preventive aspect to that, but it’s a little bit different from the other types of preventive screening or that we’re talking about where you have just an entirely healthy population without any specific additional risk factor.
The two programs that I can think of that are available to PEBB and SEBB members are the Diabetes Prevention Program, and that’s available to anybody who is 18 years or older. There are a set of screening criteria to determine whether you’re eligible for the program, and those programs actually assist folks with weight loss for members with obesity that meet those eligibility criteria for diabetes prevention.
And then PEBB and SEBB members are also able to access tobacco cessation programs for those that are 18 and older. There are some health plans that are available to PEBB and SEBB members that have programs for adolescents as well. So I would definitely recommend that folks reach out to their individual health plan to see what options are available for different age folks and their families.
Seth
Is there anything that we’ve missed regarding preventative screenings, or things that you would want to make sure people are aware of that are available through our employer provided benefits?
Heather
I would like to let people know that vaccines are still covered and available in the same way that they have always been. There’s lots of information in the news about changes that have happened from recommendations at the federal government level, but all of the health plans that provide coverage for PEBB and SEBB members have made no changes to which vaccines they cover and for which appropriate patients, those vaccines are covered.
Seth
I appreciate that reminder. I know when my wife started working in the school districts, getting more frequent flu vaccinations was something that, like, became important to us. We hadn’t really thought about it because we hadn’t been having a lot of, I think, exposure. But just herd immunity is also quite important. So, I appreciate that reminder. And I also really appreciate how many employers provide opportunities for employees to get regular vaccinations.
And I think we need to think about that. If we’re having a 45th birthday party for somebody in the office, remind them that they need to go get the colonoscopy as well. So yeah, how can we normalize these preventative care opportunities for folks? That’s great.
Jenny
But yeah, you’re right. I appreciate that DRS has offered like a flu shot clinic so that I can, you know, just come in and get it done here at the office. Not have to worry about going to Safeway or Walgreens or anything.
Seth
Yeah, normalize the experience.
Jenny
So just to quickly summarize some of what we’ve talked about today, it’s recommended that you get a vision screening at least once every two years. And also to note that the age limits have dropped recently for colorectal cancer screening and for mammograms. It’s now recommended for women to get a mammogram when you turn 40. And then for men and women to get a colorectal cancer screening when you turn 45.
And these screenings, along with wellness visits and immunizations for adults and kids, are all covered under the PEBB and SEBB health care coverage.
Seth
All right, Heather, really appreciate that. You took the time to share with our listeners about the wonderful benefits we have and how to make sure we’re staying healthy so we can enjoy our longer term retirement.
Jenny
Yeah. And obviously, if people would like more information, they can go to the website, if you would, to remind us.
Heather
Yes, that is www.hca.wa.gov.
Jenny
Well, thank you so much. And hopefully folks will go out there and take advantage of those free preventative screenings.
Heather
Thank you.
Jenny
Thanks.
Disclaimer
Thanks for listening. And now we’d love to hear from you. What topics would you like to hear about? What questions do you have for us? Send an email to drs.podcasts@drs.wa.gov that’s drs.podcasts@drs.wa.gov. The Department of Retirement Systems provides this podcast as a public service, but it’s neither a legal interpretation nor a statement of DRS policy.
References to any specific product or entity do not constitute an endorsement or recommendation. The views expressed by guests are their own, and their appearance on the program does not imply an endorsement of them or any entity they represent. Views and opinions expressed by DRS employees are those of the employees and do not necessarily reflect the view of DRS or any of its officials.
