What is Preventive Care?
Preventive care helps detect or prevent serious diseases and medical problems before they can become serious. Annual check-ups, immunizations, and flu shots, along with 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 related to services in which your provider is looking for something specific, often based on the results of a preventive test or screening. For example, a radiologist may 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:
- Annual check-up (1 per calendar year): This is when your Primary Care Provider (PCP) checks all areas of your health-- physical, as well as emotional. This can help discover any health concerns early, before they turn into major medical problems.
- Flu shot (1 per year): This is usually covered 100% under most 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 check for any signs of cancer or other irregularities. Some health plans might also 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 wants another, it's considered a diagnostic mammogram and will typically not be covered as preventive care.
- Additional 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 instance, let's say you have flu symptoms and want 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 specific problem are not covered as preventive care.
- Alternative treatments: 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 may cover this as preventive care, but several do not.
Is preventive care free?
The majority of 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 purchase on your own through the Health Insurance Marketplace. Your physician must also be in-network in order to be fully covered.
What are the benefits of preventive care?
Preventive care is meant to help you stay as healthy as possible. Routinely scheduled visits and tests allow your physician to detect any medical problems before they can become major.
Benefits of preventive care include:
- The majority of preventive care at no cost to you as part of your health coverage
- Early detection of medical conditions, illnesses, and diseases assists your physician offer 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 determine what tests and shots are right for you. They may take into consideration factors like family history, age, sex, current health status, and more.
Preventive care is usually covered 100% by your health plan and offers many benefits, both in cost and health. If you have concerns about what's covered and not covered, or when you need to have particular tests done, make sure to ask your doctor.
For more information about Dr. Linette's practice and Preventive Health in Rancho Santa Fe, California, contact us at 760-875-2627 or visit our website at LinetteWilliamson.com and schedule your appointment today!
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