What Is Preventive Care?
Preventive care helps detect or prevent serious diseases and medical problems before they can become major. Annual check-ups, immunizations, and flu shots, as well as certain tests and screenings, are a few examples of preventive care. This might 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, typically based on the results of a preventive test or screening. For instance, a radiologist may ask for a follow-up mammogram for an individual. This follow-up is to check for something that might have been detected 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:
- Annual 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 issues early, before they become major medical issues.
- Flu shot (1 per year): This is usually covered 100% under the majority of health plans and helps protect you from certain strains of the flu virus.
- Mammogram (1 per calendar year, typically after the age of 40): Routine X-rays of breast tissue to look for any signs of cancer or other abnormalities. Some health plans may also cover costs for 3D imaging.
- Colonoscopy (typically 1 per every ten years, usually 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 example if your radiologist finds something on your mammogram and requests another, it's considered a diagnostic mammogram and will generally 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. Additional visits during the same calendar year will likely not be covered as preventive. For example, let's say you have flu symptoms and want to see your physician-- that's not a covered preventive care visit.
- Specialist visits: Visits to a specialist (gastroenterologist, orthopedist, neurologist, podiatrist, etc.) for a particular issue are not covered as preventive care.
- Alternative therapies: Services such as chiropractic, massage, acupuncture, and 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 may purchase on your own through the Health Insurance Marketplace. Your physician must also be in-network in order to be completely covered.
What are the benefits of preventive care?
Preventive care is intended to help you stay as healthy as possible. Regularly scheduled visits and tests allow your doctor to detect any medical problems before they can become major.
Benefits of preventive care include:
- Most preventive care at no cost to you as part of your health coverage
- Early detection of medical conditions, illnesses, and diseases assists your physician provide proactive care and treatment
- Routine care can help you stay 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 factors like family history, age, sex, current health status, and more.
Preventive care is typically covered 100% by your health plan and provides numerous benefits, both in cost and health. If you have questions about what's covered and not covered, or when you should have certain tests done, be sure to ask your doctor.
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