What is Preventive Care?
Preventive care helps identify or prevent serious 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 can also be called routine care.
What's the difference between preventive care and diagnostic care?
Diagnostic care is associated with services in which your provider is looking for something specific, typically based on the results of a preventive test or screening. For example, a radiologist may request a follow-up mammogram for an individual. This follow-up is to check for something that might have been detected during the preventive or routine mammogram. The follow-up mammogram is diagnostic, and not covered as preventive care.
What are preventive care services?
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 discover any health concerns early, before they become major medical problems.
- 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 abnormalities. Some health plans may even cover costs for 3D imaging.
- Colonoscopy (typically 1 per every 10 years, generally 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: Most health plans will cover you for 1 yearly check-up with your doctor. Additional visits during the same calendar year will likely not be covered as preventive. For instance, let's say you have flu symptoms and want to see your physician-- 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 various other alternative health services are not considered preventive care.
- PSA blood test: This is a test to check for prostate cancer. Some health plans might cover this as preventive care, but many do not.
Is preventive care 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 must also be in-network in order to be completely covered.
What are the benefits of preventive care?
Preventive care is meant to help you remain as healthy as possible. Routinely scheduled visits and tests allow your doctor to identify any medical problems before they can become major.
Benefits of preventive care include:
- The majority of preventive care at no cost to you as part of your health coverage
- Early detection of medical conditions, illnesses, and diseases assists your physician offer proactive care and treatment
- Routine care can help you stay focused on your own health goals
How do you know what preventive care you need and when?
Your primary care provider can help you determine what tests and shots are right for you. They might look at factors like family history, age, sex, current health status, and more.
Preventive care is typically covered 100% by your health plan and offers numerous benefits, both in cost and health. If you have concerns regarding what's covered and not covered, or when you should have certain tests done, make sure to ask your doctor.
For more information about Dr. Linette's practice and Preventive Health in Carlsbad, California, contact us at 760-875-2627 or visit our website at LinetteWilliamson.com and schedule your appointment today!