Screenings Your Doctor May Not Have Mentioned: Five Preventive Tests Worth Asking About
Photo: medical screening tests laboratory blood draw preventive health clinic, via wallpaperbat.com
Preventive medicine has long operated on a straightforward principle: detecting a condition before it becomes symptomatic is almost always preferable to treating it after the fact. Yet despite decades of public health messaging and expanding insurance coverage for preventive services, a significant portion of recommended screenings go unrequested — and, consequently, unperformed — across the American patient population.
Some of this gap reflects systemic challenges: limited appointment time, fragmented care records, and the prioritization of acute concerns over long-term risk management. Some of it reflects a simple lack of awareness. Patients who do not know a test exists cannot ask for it.
This guide addresses that gap directly. The five screenings described below are supported by clinical evidence, recommended by major U.S. health organizations, and available through most standard insurance plans — yet each remains meaningfully underutilized relative to its potential impact. Where coverage and access vary by state, we have noted relevant resources to help you navigate your specific situation.
1. Lung Cancer Screening via Low-Dose CT Scan
Who it's for: Adults aged 50 to 80 who have a 20 pack-year smoking history (one pack per day for 20 years, or equivalent) and currently smoke or have quit within the past 15 years.
Lung cancer remains the leading cause of cancer-related death in the United States, accounting for more deaths annually than breast, prostate, and colorectal cancers combined. Despite this, the low-dose computed tomography (LDCT) scan — the only screening tool shown to reduce lung cancer mortality in high-risk individuals — is utilized by fewer than 6 percent of eligible Americans, according to data from the American Lung Association.
The U.S. Preventive Services Task Force (USPSTF) issued a Grade B recommendation for annual LDCT screening in eligible individuals, which means it must be covered without cost-sharing under ACA-compliant plans. However, eligibility criteria, referral practices, and imaging availability vary considerably by geography.
State-specific note: Access to LDCT screening centers is more limited in rural states. Patients in states such as Wyoming, Montana, and the Dakotas may need to travel to regional medical centers. The American College of Radiology's Lung Cancer Screening Registry (ACR LCSR) provides a searchable locator at acr.org. Many state health departments also maintain tobacco cessation and lung health programs that can facilitate referrals.
2. Abdominal Aortic Aneurysm (AAA) Ultrasound
Who it's for: Men aged 65 to 75 who have smoked at least 100 cigarettes in their lifetime.
An abdominal aortic aneurysm is an abnormal enlargement of the aorta — the body's primary artery — that can rupture without warning, carrying a mortality rate exceeding 80 percent when it does. The condition is largely asymptomatic until rupture, making one-time screening ultrasound the only reliable method of detection in at-risk individuals.
Medicare covers a one-time AAA screening ultrasound for qualifying men as part of the "Welcome to Medicare" preventive visit. Despite this, uptake remains low — in part because the screening must be requested within the first 12 months of Medicare enrollment and is not automatically offered at subsequent visits.
Women with significant smoking histories and a family history of AAA may also benefit from screening, though current USPSTF guidance does not extend a formal recommendation to this group. A frank discussion with your physician about individual risk factors is appropriate.
State-specific note: Several states, including California, New York, and Illinois, have active vascular health outreach programs through their respective departments of public health. Veterans enrolled in VA healthcare systems receive AAA screening as part of standard preventive protocols regardless of state of residence.
3. Prediabetes and Type 2 Diabetes Screening
Who it's for: Adults aged 35 to 70 who are overweight or obese; adults of any age with additional risk factors including family history, gestational diabetes history, or belonging to a higher-risk ethnic group (including Black, Hispanic, Native American, Asian American, and Pacific Islander populations).
More than 96 million American adults — approximately one in three — have prediabetes, and the CDC estimates that more than 80 percent of them are unaware of their status. Prediabetes is clinically significant not only as a precursor to type 2 diabetes but as an independent risk factor for cardiovascular disease.
Screening involves a fasting plasma glucose test or hemoglobin A1C measurement — both inexpensive, widely available, and covered under most preventive care benefits. The critical window for intervention, during which lifestyle modification can prevent or substantially delay the onset of type 2 diabetes, is most effective when prediabetes is identified early.
The CDC's National Diabetes Prevention Program (NDPP) is a federally recognized, evidence-based lifestyle intervention available in all 50 states and covered by Medicare. Private insurer coverage of NDPP varies; patients should confirm eligibility with their plan.
State-specific note: States with the highest rates of undiagnosed prediabetes include Mississippi, West Virginia, Alabama, and Louisiana. Community health centers in these states often offer free or low-cost A1C screening through state-funded diabetes prevention initiatives. The CDC's NDPP locator at cdc.gov/diabetes/prevention can identify nearby programs by zip code.
4. Hepatitis C Virus (HCV) Antibody Test
Who it's for: All adults aged 18 to 79, per USPSTF Grade B recommendation; individuals born between 1945 and 1965 (the "baby boomer" cohort) are at particularly elevated risk.
Hepatitis C is a blood-borne viral infection that can persist asymptomatically for decades while causing progressive liver damage, cirrhosis, and hepatocellular carcinoma. The CDC estimates that approximately 2.4 million Americans are currently living with chronic HCV infection, and a substantial proportion remain undiagnosed.
The development of direct-acting antiviral (DAA) therapies has transformed HCV treatment — cure rates now exceed 95 percent with an 8- to 12-week oral medication course. This makes detection not merely informative but genuinely curative in most cases. Despite this, HCV screening rates remain well below the levels recommended by national health authorities.
A one-time HCV antibody test is covered without cost-sharing under the ACA for adults within the recommended age range. Individuals with ongoing risk factors (including certain medical procedures performed before 1992, past injection drug use, or receipt of blood transfusions before 1992) may qualify for additional testing.
State-specific note: Several states — including New York, California, Washington, and Colorado — have enacted hepatitis C elimination initiatives that expand testing access through community pharmacies, federally qualified health centers, and harm reduction programs. Patients in states with less robust public health infrastructure may need to specifically request HCV testing during routine bloodwork, as it is not always included automatically.
5. Depression and Anxiety Screening
Who it's for: All adults, including pregnant and postpartum women; adolescents aged 12 and older.
Mental health screening may not fit the traditional image of a "medical test," but validated tools such as the Patient Health Questionnaire-9 (PHQ-9) for depression and the Generalized Anxiety Disorder-7 (GAD-7) scale represent genuine clinical assessments with meaningful implications for treatment planning. The USPSTF recommends routine depression screening for all adults, yet studies consistently show that a substantial proportion of primary care visits do not include any formal mental health assessment.
Depression and anxiety are among the most prevalent — and most undertreated — conditions in the United States. The American Psychiatric Association estimates that fewer than half of adults with diagnosable depression receive treatment. Early identification through routine screening enables timely intervention, whether through counseling, medication, or integrated behavioral health services.
Under the Mental Health Parity and Addiction Equity Act and the ACA, mental health services must be covered comparably to medical and surgical services by most insurance plans. Screening itself is a covered preventive service at no cost-sharing for eligible patients.
State-specific note: Access to mental health follow-up care varies dramatically by state. States with the most robust integrated behavioral health networks include Massachusetts, Vermont, and Oregon. Patients in states with significant mental health provider shortages — including Texas, Georgia, and many rural states — may benefit from telehealth-based mental health platforms, many of which accept major insurance plans. SAMHSA's National Helpline (1-800-662-4357) provides free referral assistance nationwide.
Starting the Conversation With Your Provider
Knowing which screenings exist is only the first step. Translating that knowledge into action requires a direct conversation with your primary care provider, ideally during a scheduled annual wellness visit rather than an acute care appointment when clinical priorities are necessarily different.
Consider preparing a brief written list of the screenings you wish to discuss, including your age, relevant family history, and any lifestyle risk factors. This preparation not only makes the conversation more efficient but signals to your care team that you are an engaged, informed participant in your own health management.
At RSB Health Institute, we believe that access to clear, evidence-based health information is a prerequisite for informed decision-making. The screenings described in this guide are not obscure or experimental — they are established, covered, and available. The decision to ask about them may prove to be among the most consequential health choices you make this year.
