Health insurance plans help cover thousands of services and treatments — like office visits, blood tests, and medical treatments. They also typically must cover a set of preventive care services. But how does preventive care differ from diagnostic care and what kinds of treatments or services are included? Read on to learn more.
What is preventive care?
Preventive care is routine health care that helps prevent diseases, illnesses and other health issues.1 You may know it better as a routine checkup that you schedule with your healthcare providers. Most health insurance plans are required to cover certain preventive services — typically at no cost when you see an in-network provider.2
The importance of preventive healthcare
Scheduling and receiving preventive care is an important part of maintaining your health. Doctors can use routine checkups to assess your overall health based on things like your sex, age, genetics and current health condition. It’s also an opportunity to catch any health problems before symptoms may show up — which can mean starting treatment earlier and potentially having a better prognosis or recovery.
What’s the difference between preventive care and diagnostic care?
You can think of diagnostic care as the opposite of preventive care; it includes services that help healthcare providers determine symptoms and diagnose health problems.3 Doctors usually perform diagnostic tests when you’re not feeling well, if you’re managing a condition or if they find something during a routine checkup.
This means there may be times when you go in for preventive services, and the doctor decides to run diagnostic tests based on what they found. In this case, even though your preventive services are covered, you may have to pay for the diagnostic tests according to your insurance policy — such as a copay or coinsurance.3
What preventive care services are covered?
When you see a doctor for your routine checkup, some of the services that can be covered under preventive care include:2
- Screening tests for blood pressure, cholesterol, diabetes and certain infections
- Breastfeeding support and counseling
- Immunizations, such as flu shots, HPV vaccines, shingles vaccines and tetanus shots
- Obesity and diet counseling
- Well-woman, well-baby and well-child visits (also called annual checkups or physicals)
- Developmental screenings for children
- Depression screenings
- Mammograms and cervical cancer screenings (pap smears)
- Colorectal cancer screenings
These services are typically offered at no additional cost when you see an in-network provider.2
Dental and vision preventive services
Health insurance isn’t the only kind of insurance that covers preventive care. Typically, vision and dental insurance plans cover services like routine exams and teeth cleanings at no cost when you see an in-network provider. Since this can vary by insurance provider, check your plan for exact coverage details.
What services aren’t considered preventive care?
Usually, any service performed that’s meant to diagnose or treat a health problem isn’t considered preventive care, and you’ll likely be billed for it. Some of these services can include:
- Diagnostic tests
- Specialist visits
- PCP office visits outside of your routine checkup
- Services or treatments that help manage an existing or new health condition
Get the level of coverage you need
While preventive care may be fully covered under most insurance plans, it may lead to further diagnostic testing or specialist visits — which can lead to out-of-pocket costs. Check your plan to learn about any diagnostic care deductibles and copays you may be responsible for.
You can also enroll in other insurance plans to help with costs. Plans for accident insurance, hospital indemnity insurance, critical illness insurance and cancer insurance can provide lump sump payments for covered incidents the recipients can use however they see fit. Some supplemental health plans even give you a small payment in exchange for undergoing particular screenings and preventive care, such as blood work to determine cholesterol levels.
Speak with your employer’s human resources department to see what type of supplemental health plans they offer. Carefully review any benefit plan material available and then, during open enrollment, be sure to update your coverage to what works best for you and your budget.