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What is preventive care and what services are covered? • Benzinga


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Preventive care is routine care to help people stay healthy and prevent serious illnesses and diseases. Most preventative care services are fully covered by insurance companies, but it’s important to understand exactly what is and isn’t included. Here’s what you need to know.

What is preventive care?

Preventive care (also called routine care) helps detect and prevent serious illnesses and medical problems. Some of the common components of preventive care are:

Annual reports: It is recommended that most adults see their primary care provider (PCP) once a year for an exam when your doctor examines you and performs routine tests such as checking blood pressure. If you have any concerns or questions about your health, you can discuss them with your doctor during your annual health check. Your doctor may also recommend other diagnoses if they are concerned about something that comes up during your visit.

Vaccine against influenza: An annual flu shot is recommended for most people to protect against serious illness during flu season. You can get your flu shot at your doctor’s office or at a participating pharmacy. Most health insurance plans provide full coverage for flu shots.

Additional vaccines: Other vaccinations are also considered preventative care. Most vaccines are given in childhood, but some vaccines require occasional boosters.

Mammograms: Mammograms are an important part of preventive care for women. These are routine x-rays of breast tissue to check for signs of abnormalities or cancer. It is recommended that women start having mammograms every year after age 45, although some women aged 55 and over may choose to have a mammogram every two years. Women can also have mammograms before age 45 if recommended by a doctor. Men and non-binary people may also be eligible for mammograms, especially if they have a genetic mutation that increases their risk of developing breast cancer.

Colonoscopy: Colonoscopy is part of routine preventive care for anyone over 50. The procedure screens for colon cancer, and in most cases a colonoscopy is recommended every five to 10 years. Some doctors may recommend colonoscopies before age 50 or more frequently, especially if the patient has a family history of colorectal cancer or polyps.

What is diagnostic support?

Diagnostic care is different from preventive care because it includes health care services and procedures that involve the investigation and treatment of a health problem. Diagnostic care can occur as a result of something discovered during a preventive care visit or procedure.

Tests and screenings: If your doctor is concerned about a possible health problem, they may recommend diagnostic tests and screenings. For example, if you tell your doctor during your annual exam that you’re concerned about your digestive health, they may recommend a colonoscopy. Although colonoscopies are an integral part of preventive health care, if your doctor recommends it for a non-routine reason like this, that is diagnostic care, not preventive care.

Additional office visits: Most health insurance plans only cover one visit to your PCP each year for your annual checkup. If you see your doctor at other times of the year, it is not considered part of your preventive care. Common reasons for seeing your doctor outside of your annual checkup include treating flu-like symptoms or an injury such as a sprained ankle.

Specialized visits: Preventive care usually only includes visits to your PCP. If you see a specialist such as a gastroenterologist or an orthopaedist, this is not part of preventive care.

Alternative therapies: Although some alternative health services may be considered preventive care measures, they are generally not included in the insurance company’s definition of preventive care. Some alternative therapies may include acupuncture, chiropractic services, and massage.

The PSA blood test: The prostate specific antigen (PSA) test is primarily used to screen for prostate cancer. Some insurance companies may include this in their preventive care benefits, but many consider it a diagnostic care procedure.

The Benefits of Preventive Care

If you’re healthy, you might be wondering why you should bother going to the doctor for preventative care. While you may not like making time to go to the doctor in your busy schedule, there’s no denying the benefits of preventative care.

Little or no cost: Most health insurance plans are legally required to cover 100% of eligible preventative care expenses, such as an annual exam.

Early detection: Regular preventative care can help you and your doctor catch signs of serious health problems early. By catching problems early, they can be easier to treat and reduce the impact on your overall health.

Achieve health goals: Establishing and maintaining a relationship with your PCP will allow you to get answers to your health-related questions. It also helps your PCP get to know you and your health goals so they can help you achieve them. For example, if you want to lose weight or improve your cardiovascular fitness, your PCP can help you monitor your progress and give you suggestions as needed.

Are all preventive care covered?

Most health plans are required to cover preventative services such as vaccinations, annual checkups, and routine drug tests. All plans offered on the health insurance market are subject to these requirements, and some plans outside the market may have the same requirements.

There are exceptions to be aware of. For example, your health insurance plan may be required to cover your preventative health services, but it may also have requirements for you. Most health insurance plans have a network of doctors and providers who accept their plan. If you see a doctor for preventive care but the doctor does not accept your insurance plan, your preventive care may not be free. In these cases, your insurance may only cover part of the expense or you may be responsible for the entire bill.

Compare health insurance

Finding the right health insurance plan can be a major headache. That’s why Benzinga regularly researches and reviews the best healthcare providers to help you choose the plan that will give you the best care. Take a look at some of the best health insurance providers for your preventative care needs.

Who needs preventive care?

Whether it’s a child or an adult, everyone benefits from preventive care. That’s why most health insurance providers are required to cover 100% of eligible preventative health care services. Benzinga’s guide to health insurance can help you navigate plans to find the one that’s right for you.

Frequently Asked Questions

What is meant by preventive care?

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What is meant by preventive care?

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Sarah Horvat

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Preventive care is routine care intended to prevent and detect medical conditions, including serious illnesses. Annual checkups with a primary care physician, flu shots, other routine vaccinations, and routine testing and screening are all considered preventative care.

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What is preventive care?

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What is preventive care?

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Sarah Horvat

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The goal of preventive care is to establish a relationship between doctor and patient to help the patient stay healthy. Getting the flu shot or any other major vaccine reduces your risk of getting seriously ill from a virus. Routine tests and screenings establish a baseline for the patient so doctors can more easily detect abnormalities. Annual health checkups also allow patients to report any health problems or questions to their doctor. If needed, a PCP can recommend diagnostic care to treat something that was found during a preventive care appointment or procedure.

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