What is Preventive Care?
Preventive care helps identify or prevent major illnesses and medical problems before they can become serious. Annual check-ups, immunizations, and flu shots, along with 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 associated with services in which your provider is looking for something specific, usually based on the results of a preventive test or screening. For instance, a radiologist may ask for a follow-up mammogram for an individual. 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.
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, and psychological. This can help detect any health problems early, before they turn into major medical issues.
- Flu shot (1 per year): This is typically covered 100% under the majority of health plans and helps protect you from certain strains of the flu virus.
- Mammogram (1 per calendar year, typically after the age of 40): Routine X-rays of breast tissue to look for any signs of cancer or other irregularities. Some health plans may even cover costs for 3D imaging.
- Colonoscopy (generally 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 example 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. Other visits during the same calendar year will likely not be covered as preventive. For example, 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 issue are not covered as preventive care.
- Alternative treatments: 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 might cover this as preventive care, but several 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 purchase on your own through the Health Insurance Marketplace. Your doctor has to also be in-network in order to be completely covered.
What are the benefits of preventive care?
Preventive care is meant to help you stay as healthy as possible. Routinely scheduled visits and tests allow your doctor to detect any medical problems before they can become serious.
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 doctor 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 coordinate what tests and shots are right for you. They may take into consideration factors like family history, age, sex, current health status, and more.
Preventive care is typically 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 should have particular tests done, make sure to ask your physician.
For more information about Dr. Linette's practice and Preventive Health in Rancho Bernardo, California, contact us at 760-875-2627 or visit our website at LinetteWilliamson.com and schedule your appointment today!