What is preventative care?

Preventative care is also known as routine care. It differs from diagnostic care in that diagnostic care involves services in which your medical provider is searching for specifics that stem from a preventative test or screening. Preventative care can help identify or prevent serious medical conditions before they turn into a life-threatening situation.  

Examples of Preventative Care Services 

• Annual 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 detect any health concerns early, before they become major medical problems. 

• Colonoscopy (typically 1 per every 10 years, usually after the age of 50): Screening for colon cancer. 

• Flu shot (1 per year): This is typically covered 100% under most 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 also cover costs for 3D imaging. 

• Vaccinations (usually administered during childhood, includes boosters as needed): Vaccinations like measles, mumps, rubella, polio, etc. are covered at 100%. 

Examples of Non-preventative Care 

• Additional primary care visits: Most health plans will cover you for 1 annual check-up with your doctor. Other visits during the same calendar year will likely not be covered as preventative. For example, let’s say you have flu symptoms and need to see your doctor—that’s not a covered preventative care visit. 

• Alternative therapies: Services such as chiropractic, massage, acupuncture, and other alternative health services are not considered preventative care. 

• Diagnostic tests and screenings: These are not routine tests and screenings. For instance, as long as your radiologist finds something on your mammogram and wants another, it is regarded as a diagnostic mammogram and will usually not be covered as preventative care. 

• Prostate-Specific Antigen (PSA) blood test: This is a test to check for prostate cancer. Some health plans may cover this as preventative care, but many do not. 

• Specialist visits: Visits to a specialist (gastroenterologist, orthopedist, neurologist, podiatrist, etc.) for a particular problem are not covered as preventative care. 

Is preventative care covered by health insurance? 

Most health plans are required by law to cover eligible preventative 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 doctor must also be in-network in order to be fully covered. 

Benefits of Preventative Care 

• Early detection of medical problems, illnesses, and diseases helps your doctor provide proactive care and treatment 

• Most preventative care at no cost to you as part of your health coverage 

• Routine care can help you stay focused on your own health goals 

Here is a list of our insurance partners which provide the best medical coverage for preventative care (wellness benefits).