Preventive care helps detect or prevent serious diseases and other medical issues before they become worse.

Preventive care procedures and visits include things you may already be familiar with, including annual physicals, flu shots, and immunizations.

Preventive care is different from diagnostic care, which is when your doctor is looking to diagnose an illness or condition based on symptoms you may be having.

What is preventive care?

Preventive health care consists of seeing your doctor for regular checkups and undergoing various recommended tests in order to keep certain medical conditions or illnesses from developing or worsening.

These conditions could include various forms of cancer, which is why women are screened for cervical cancer with pap smears and breast cancer with mammograms. Colon cancer is another illness that can possibly be prevented based on preventive care-related screenings.

Of course, there is never a guarantee that a condition can be completely avoided, but the sooner an illness is discovered, the greater the chances are that the person will survive the condition. For instance, if a person is diagnosed with breast cancer that is stage 1 or stage 2, then it’s a lot easier to treat, since the tumor is small and often hasn’t spread to other organs.

If a person’s breast cancer isn’t diagnosed until stage 3 or 4, then there is a greater chance that the cancer can spread. There is also an increased chance that the person may not survive the cancer, since it wasn’t caught early. Even when preventive care is unable to completely prevent a disease from  manifesting, it can enable medical professionals to catch the disease early enough so it can be completely reversed in many cases.

What procedures are considered preventive care?

Some common examples of preventive care include:

• Yearly physicals or check-ups – This is when your primary care physician checks over your general health. These visits are important as they can help detect any health concerns early and are a great opportunity to bring up anything you may be worried about with your doctor. You can expect your health insurance to cover these visits once a year.
• Flu shots – Every year, based on surveillance data of which strains of the flu are expected to circulate, a determination is made on which strains of the flu to vaccinate against. Insurance plans are typically expected to cover 100% of the cost to get this vaccine.
• Mammograms – After 40, or younger if you are at a higher risk for developing breast cancer, yearly X-rays of breast tissue are taken to detect early signs of cancer or other abnormalities.
• Colonoscopy – After 50, or younger if you are at a higher risk for colorectal cancer, a screening is done for colon cancer. You can expect to receive these once every 10 years.
• Vaccinations – Vaccinations (e.g., measles, mumps, rubella, polio), are administered during childhood with boosters as needed.
• Well woman visits – After age 20, it’s common for women to receive biannual pap smears and other STD checks.

These are just some examples of preventive care visits and procedures. Your primary care provider can help you decide and coordinate what tests and shots are right for you. The preventive care services you should get will vary based on factors such as: age, gender, health status, and family history.

How do health insurance plans tend to cover preventive care?

Prior to the Affordable Care Act (ACA), it was often necessary for policyholders to pay for all or some of their preventive care. However, since the ACA was passed, health insurance plans must cover 100% of preventive care.

This means that your annual physical, including recommended tests, are now completely covered, with no out-of-pocket costs. So, regardless of whether a health plan is through an employer or the Marketplace, it must cover preventive care 100%, and you won’t have to pay copays, coinsurance, or any other costs. 

If you have questions about which tests you can expect to be covered versus not covered, be sure to ask your doctor or health insurance provider.

What are some common procedures that are NOT considered preventive care?

Diagnostic care and other specialist visits typically do not qualify as preventive care. Some examples of non-preventive care include:

• Additional primary care visits – Most health insurance plans will cover 1 annual check-up visit with your doctor. Other visits to your primary care physician are not covered under primary care.
• Diagnostic tests and screenings – These are used to detect ailments or conditions that are not able to be identified via routine tests or screenings.
• Specialist visit – If you need to go to a specialist for any reason, this does not count as preventive care.
• Alternative therapies – Services such as chiropractic, massage, acupuncture, and other alternative medicine are not considered preventive care.

What are the benefits of getting preventive care services?

Receiving preventive care is important for health maintenance as it helps you identify health issues early. Even if you are feeling overall healthy, it’s still important to make it into your doctor’s office for preventive care appointments—like your routine physicals and check-ups. Even if nothing is wrong, it’s better to be safe than sorry when it comes to your health. Plus, the ACA requires your health insurance to cover the full cost of these visits and services!

In addition to extending your life, there are many other health benefits of preventive care services. For example, you can enjoy a better quality of life. Even if you develop a non-life-threatening illness, it could still negatively affect your quality of life, especially when in the later stages of the disease. With preventive care, the condition can be diagnosed early, significantly improving your chances of making a full recovery from whatever illness you’re facing or starting a management routine to mitigate symptoms and side effects. 

An additional benefit of preventive care services is the potential to save a great deal of money. If a disease is avoided or caught in its early stages, then treatment is usually much cheaper than if a disease is allowed to progress to its later stages. 

Find a health insurance plan that will cover preventive care today

Preventive care is providing medical care to keep potential health conditions at bay. The Affordable Care Act ensures that everyone, regardless of the type of insurance they have, has access to free preventive care. 

If you need to sign up for a health care plan and you’re not sure where to begin, eHealth can provide you with information about signing up for Marketplace health insurance, applying for Medicaid, and more. eHealth employees are available to quickly answer any further questions that you may have about preventive care and health insurance in general. Contact eHealth today so you can be on your way to having health insurance that you can depend on to provide preventive care coverage that helps you keep healthy for as long as possible.