What Are Preventative Care Services?
Preventative care refers to minor procedures scheduled to prevent disease, illness, or other health problems before symptoms arise. By monitoring your mental and physical well-being, doctors can learn more about your general state and share information and tools that help keep you healthy. This type of healthcare includes routine checkups, preventive screenings, tests, immunizations, and patient counseling.
Abiding by a regular preventative care schedule can also help catch and efficiently treat concerning issues at their onset. For example, annual screenings can help your doctor identify and strategize against conditions such as high blood pressure or cancer before they worsen. Most health insurance plans cover the total cost of preventative services for patients who see in-network providers.
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The Importance of Staying On Top of Your Health
Preventative care increases your chances of a healthier life, lowering your long-term out-of-pocket medical expenses. Standard vaccines and routine health monitoring significantly reduce the risk of disease, disability, and death, especially in children and older adults with vulnerable immune systems. Unfortunately, primarily due to insurance access and awareness barriers, millions of Americans do not receive the preventative care needed to stay healthy.
For example, thousands of people die from the flu each year. By simply receiving a complimentary vaccine from a doctor or primary care clinic in your insurer’s healthcare network, you limit the possibility and severity of contracting influenza, minimizing the spread of a disease that often results in hospitalization.
How Does Health Insurance Cover Preventive Care?
By law, most health insurance plans must cover 100% of all eligible preventative services, including annual checkups, cancer screenings, flu shots, and immunizations. By staying on top of your monthly premium, you automatically qualify for free preventative care. Unlike similar diagnostic services, you would not have to chip in to share costs with your insurer. Cost-sharing exemptions include:
- Copayments: These small fees due are with each doctor’s appointment.
- Coinsurance: This is the percentage of medical fees you typically owe after your insurance pays the bulk of your bill.
- Deductibles: This is the annual limit you usually would have to pay out-of-pocket before insurance coverage kicks in.
What Qualifies as a Preventative Service?
Preventive health care describes routine appointments, screenings, and minor procedures that monitor and maintain your general health. Typically, these services focus on testing for medical conditions before you exhibit symptoms. By catching health concerns early on, doctors can craft and administer a suitable treatment plan more effectively.
Patients who see medical providers explicitly listed in their insurer’s healthcare network should qualify for free preventative care. Examples of these services include:
- Flu and pneumonia shots
- Well-women, well-baby, and well-child visits
- Breastfeeding support
- Blood pressure, cholesterol, and cancer screenings
- Depression and alcohol misuse screenings
- Smoking and weight loss counseling
- STD screenings
- Routine vaccinations
What Does Not Qualify as a Preventative Service?
Qualified preventative care only extends to medical services received while a patient still exhibits good health. Once doctors identify a problem, they will bill similar or identical services as diagnostic care, requiring some patient cost-sharing. For example, if a free mammogram uncovers signs of breast cancer, your doctor will schedule future diagnostic mammograms to monitor your known condition.
Patients must also pay for preventive services exceeding their policy’s annual limit. Preventive care visits to specialists such as dermatologists or orthopedists and alternative therapy treatments such as acupuncture or massage do not qualify for total coverage. Likewise, preventative measures performed by an out-of-network provider will require a deductible and some copay or coinsurance.
Types of Preventative Care Services
Preventive health services take many forms, all available through clinics and doctors in your insurance provider’s medical network.
Patients should undergo routine screenings to search for potential disorders or diseases before symptoms arise. As you age, doctors will recommend an increase in preventative exams, including:
- Annual checkups: As part of a general physical, your doctor will test you for high blood pressure, cholesterol, STDs, and other common health issues for no out-of-pocket cost.
- Cancer screenings: Because cancer has proven most treatable in its earliest stages, men and women should schedule routine PSA tests, pap smears, mammograms, and colonoscopies beginning in their 40s.
- Diabetes testing: Regardless of your weight, the ADA recommends adults over 45 begin scheduling preventative prediabetes and diabetes screenings.
Vaccinations and Immunizations
Vaccinations, interchangeably known as immunizations, are biological formulas that prepare and protect our bodies from disease. Typically administered via injection, most vaccines qualify as preventative care, including:
- Annual flu shots: Prevent hospitalization due to the spread of influenza, a common infection of the nose, throat, and lungs.
- Childhood immunizations: We receive most major vaccines as children, including hepatitis A and B, chicken pox, measles, diphtheria, tetanus, whooping cough, and COVID-19 shots.
- Adult immunizations: Insurance will cover critical vaccines missed during youth and Tdap (tetanus-diphtheria-pertussis) boosters due every ten years.
Counseling and Behavioral Therapy
Wellness counseling and behavioral therapy share valuable tools and information with individuals who need help prioritizing their health and well-being. Guidance includes:
- Weight loss counseling: Along with diet and exercise advice, cognitive-behavioral therapy helps patients overcome the mental hurdle of losing weight.
- Addiction counseling: Support and recovery strategies for people who abuse substances such as tobacco, alcohol, or recreational drugs.
- Depression screenings: Questionnaires that help doctors identify mental health disorders and determine the proper treatment.
How Much Do Preventative Services Cost?
According to federal law, all health insurance providers must fully cover eligible preventative care for members who see in-network doctors. These insurance companies cannot ask patients to share costs through copays, coinsurance, or deductibles for any exams, vaccines, or counseling billed as preventative care.
Though rates will vary from state to state, the average cost of a routine physical without insurance falls at $238 nationwide, whereas basic flu shots typically cost around $43 out-of-pocket. According to the CDC, out-of-pocket colonoscopy costs can range anywhere from $1,714 to $3,962 nationwide. Unfortunately, the high prices of these standard services often deter uninsured individuals from seeking the care necessary to stay healthy.
Accessing Preventative Care Services With Health Insurance
To access complimentary care, simply follow these steps:
- Determine what preventative care you need. Medical experts recommend scheduling healthcare maintenance on a routine basis, typically every one to two years, depending on the procedure. Call your primary care clinic to determine the next service due on your medical record.
- Confirm what services qualify as preventative. Contact your insurer to clarify your cost-sharing responsibilities for all eligible healthcare.
- Receive care from an in-network doctor. Preventative services only qualify for total coverage if your doctor exists within your insurer’s medical network and the procedure does not exceed your annual allotment.
Your medical provider will then directly invoice your insurer, which should automatically pay the bill for you.
How Often Should You Get a Preventative Service?
Covered preventative care depends on your age, the procedure, and your insurer. Insurance typically covers one preventative health checkup and routine physical per year. Alternatively, the CDC recommends that symptom-free women over 45 schedule preventive mammograms every two years and that healthy individuals over 50 receive one colonoscopy every ten years. While most immunizations only necessitate one or two initial injections, some, such as the Tdap vaccine, require occasional boosters.
All in All
Regular screenings are crucial in preventing, identifying, and treating common problems such as cancer, high blood pressure, and diabetes early on, whereas vaccines neutralize the possibility of spreading certain infections and diseases. Behavioral therapy, meanwhile, guides people through depression and substance dependencies that could lead to severe physical and mental side effects. All in all, these covered services aim to improve and maintain public health and well-being.
As dictated by law, health insurance providers must cover the total cost of preventative care for no patient copay, coinsurance, or deductible. Contact your primary care provider to find out when you are due for your next preventative service and receive the care you need to live a longer, healthier life.