What Is Preventive Care? Does My Health Insurance Cover the Cost?

Preventive care is a topic that is always present but is rarely discussed in detail. Hence, there is a lot of confusion surrounding preventive care - about what really counts as preventive care and what does not. Preventive care is often recommended for you by your doctor or by your insurance company. If you have any doubts about preventive care and whether your health insurance covers it, you can consult your health insurance broker. But first, read through this article since we explain in simple terms what qualifies as preventive care and what doesn’t.

What Is Preventive Care?

Preventive care covers all the services that prevent major medical conditions and diseases. This means preventive care will help you avoid getting sick with services like immunizations, screenings and regular check-ups. 

People often confuse preventive care with diagnostic care but they are different. While preventive care is focused on general health, diagnostic care services look for something specific. Diagnostic care often comes after the doctors find something suspicious in the preventive tests or screening. For example, your routine cancer screening tests come under preventive care but the follow-up biopsy that checks for the specific cancer comes under diagnostic care. 

What Services Come Under Preventive Care?

The best thing about preventive care is that these services come free of cost. Most health plans are required to cover preventive care without the insurer spending a penny for the doctor or clinic and without needing to pay the deductible. You will just have to find a doctor who is covered by your plan. Here we list some of the preventive care services that you can avail without spending from your pocket.

1. Annual Check-Ups: Your insurance covers annual check-ups that include physical examination along with miscellaneous health screenings for cholesterol, high BP and other such health conditions. This helps you find any medical condition early.

2. Flu Shots: These include shots which will protect you from the risk of developing flu and even if you do get infected, the flu shot can fight it before it becomes serious.

3. Vaccinations for Both Adults and Children: Vaccinations for children include chickenpox, measles, hepatitis A and B and will include boosters as needed. As for adults, there are Tdap boosters and immunizations against pneumococcal conjugate and shingles.

4. Cancer Screenings: It is hard for cancer to show symptoms in the early stages and this is why it is important to get regular cancer screening done. When the cancer is identified at an early stage, it can be treated and at times even cured. For men, screening for the most recurrent cancers like prostate cancer and colon cancer is advised; for women breast cancer screening, cervical cancer screening, etc. are advised.

Some of the services that do not come under preventive care are specialist doctor visits, diagnostic tests, PSA blood test and such. The list of what’s included and what’s not in preventive care services differs for children, women and men. 

Which Plans Cover Preventive Care Costs?

Now that you know what exactly preventive care is, the next thing that you will have to do is find out whether your insurance plan covers the cost of preventive care services. 

Since the implementation of Affordable Care Act (ACA), preventive care has to be covered by every health insurance plan that is regulated by the act. Thus, your health plan would normally cover the cost of preventive care services unless your health plan is grandfathered.

Grandfathered health plans are the ones that were in existence till March 23, 2013 and have remained the same without many changes. These plans do not have to provide any benefits required by the Affordable Care Act. 

Therefore, determine the type of health plan that you have to find out whether preventive care is covered. Consult your insurance company or your health insurance broker for clarifications. 

Allied Brokers

We have been in the insurance industry for over 60+ years and thus our expertise can provide you with better benefits. Our health insurance broker can help you with the details and for this you just have to visit us at https://alliedbrokers.com/health-insurance-broker-near-me.html