What is Preventive Care?
Preventive care helps discover or prevent major illnesses and medical problems before they can become major. Annual check-ups, immunizations, and flu shots, along with certain tests and screenings, are a few examples of preventive care. This can also be called routine care.
What's the difference between preventive care and diagnostic care?
Diagnostic care is associated with services in which your provider is looking for something specific, usually based on the results of a preventive test or screening. For instance, a radiologist might request a follow-up mammogram for an individual. This follow-up is to check for something that might have been discovered during the preventive or routine mammogram. The follow-up mammogram is diagnostic, and not covered as preventive care.
What are preventive care services?
Examples of preventive health services and their frequency:
- Yearly check-up (1 per calendar year): This is when your Primary Care Provider (PCP) checks all areas of your health-- physical, and emotional. This can help detect any health problems early, before they become major medical issues.
- Flu shot (1 per year): This is typically covered 100% under the majority of health plans and helps protect you from certain strains of the flu virus.
- Mammogram (1 per calendar year, usually after the age of 40): Routine X-rays of breast tissue to check for any signs of cancer or other abnormalities. Some health plans may even cover costs for 3D imaging.
- Colonoscopy (typically 1 per every ten years, generally after the age of 50): Screening for colon cancer.
- Vaccinations (normally administered during childhood, includes boosters as needed): Vaccinations like measles, mumps, rubella, polio, etc. are covered at 100%.
Examples of non-preventive care include:
- Diagnostic tests and screenings: These are not routine tests and screenings. For instance if your radiologist discovers something on your mammogram and requests another, it's considered a diagnostic mammogram and will typically not be covered as preventive care.
- Extra primary care visits: The majority of health plans will cover you for 1 annual check-up with your doctor. Other visits during the same calendar year will likely not be covered as preventive. For example, let's say you have flu symptoms and need to see your doctor-- that's not a covered preventive care visit.
- Specialist visits: Visits to a specialist (gastroenterologist, orthopedist, neurologist, podiatrist, etc.) for a particular problem are not covered as preventive care.
- Alternative therapies: Services such as chiropractic, massage, acupuncture, and various other alternative health services are not considered preventive care.
- PSA blood test: This is a test to check for prostate cancer. Some health plans might cover this as preventive care, but many do not.
Is preventive care free?
Most health plans are required by law to cover eligible preventive care services at 100%. This includes health insurance plans you get through your employer along with those you might buy on your own through the Health Insurance Marketplace. Your physician has to also be in-network in order to be fully covered.
What are the benefits of preventive care?
Preventive care is meant to help you remain as healthy as possible. Routinely scheduled visits and tests allow your doctor to detect any medical problems before they can become serious.
Benefits of preventive care include:
- The majority of preventive care at no charge to you as part of your health coverage
- Early detection of medical problems, illnesses, and diseases aids your physician offer proactive care and treatment
- Routine care can help you remain focused on your own health goals
How do you know what preventive care you need and when?
Your primary care provider can help you decide what tests and shots are right for you. They might take into consideration things like family history, age, sex, current health status, and more.
Preventive care is usually covered 100% by your health plan and provides many benefits, both in cost and health. If you have concerns regarding what's covered and not covered, or when you need to have particular tests done, be sure to ask your physician.
For more information about Dr. Linette's practice and Preventative Health in El Cajon, California, contact us at 760-875-2627 or visit our website at LinetteWilliamson.com and schedule your appointment today!
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