What is Preventive Care?
Preventive care helps detect or prevent major diseases and medical problems before they can become major. Annual check-ups, immunizations, and flu shots, as well as 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 might request a follow-up mammogram for a patient. This follow-up is to check for something that may have been discovered during the preventive or routine mammogram. The follow-up mammogram is diagnostic, and not covered as preventive care.
Preventive Care in Carlsbad
Examples of preventive health services and their frequency:
- Yearly 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 identify any health concerns early, before they turn into major medical issues.
- Flu shot (1 per year): This is generally covered 100% under the majority of health plans and helps protect you from certain strains of the flu virus.
- Mammogram (1 per calendar year, usually 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 even cover costs for 3D imaging.
- Colonoscopy (usually 1 per every 10 years, usually 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 finds something on your mammogram and requests 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 yearly check-up with your physician. Additional visits during the same calendar year will likely not be covered as preventive. For instance, let's say you have flu symptoms and need 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 therapies: 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 many do not.
Is preventive health care in Carlsbad 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 as well as those you may buy on your own through the Health Insurance Marketplace. Your physician has to also be in-network in order to be completely covered.
What are the benefits of preventive care?
Preventive care is intended to help you remain as healthy as possible. Regularly scheduled visits and tests allow your doctor to identify any medical problems before they can become major.
Benefits of preventive care include:
- Most preventive care at no charge to you as part of your health coverage
- Early detection of medical problems, illnesses, and diseases aids your physician offer proactive care and treatment
- Routine care can help you remain focused on your own health goals
How do you know what preventive care you need and when?
Your primary care provider can help you decide what tests and shots are right for you. They might look at things like family history, age, sex, current health status, and more.
Preventive care is often covered 100% by your health plan and provides 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.
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