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Preventive Care

One of the most essential ways to get the most out of your health plan is to utilize its free (well, no additional charge) preventive care benefits. Preventive services are offered to every policyholder, regardless of the type of health plan you have. Whether you’re insured with a high-deductible HSA, a catastrophic plan, or a fully comprehensive plan, recommended exams, screenings, and other services are available at no cost. A full list of such services for adults, women, and children, including new additions introduced by the Affordable Care Act can be viewed here.

Saving money on health care and keeping yourself free of common illnesses and conditions starts with these services. Since it is no additional charge, you can keep your peace of mind and your savings by getting annual exams from the OB/GYN, immunizations for children, or cancer screenings before you procrastinate on your health. As we live in a culture who puts off tasks, even avoids health care for cost and scheduling reasons, we need to take the time to get these services done. However uncomfortable it may be, it is certainly worth the effort in the long run. Especially because it doesn’t cost anything extra in addition to your health insurance.


Preventive Care and Health InsuranceWhat is Preventive Care?

Preventive services include a broad range of programs and procedures to help people stay healthy. Whether you’re insured under Medicaid, Medicare, a group plan, or an individual plan, as long as your plan isn’t grandfathered (issued before March 23, 2010), you have access to each of these services at no cost. Even certain plans that could be considered grandfathered are now complying with such provisions in order to keep their members safe. If you are still under a grandfathered plan, however, you may not be able to receive these services for free. Some example of preventive care include:

  • Diabetes, blood pressure, and cholesterol screenings
  • Mammograms, colonoscopies, cervical exams, prostate exams, and various other cancer screenings
  • Well-baby and well-child visits for young people up to age 21 (these include a wide array of assessments and screenings for total wellness, from behavioral health and weight control to immunizations)
  • Vaccinations for pneumonia and influenza viruses
  • Shots for measles, meningitis, polio, and other diseases
  • Advice, education, and informational resources on various ways to stay well, including tobacco cessation, weight loss, nutrition, depression treatment, and lowering alcohol use
  • Prenatal care, education, counseling, and exams


How to Ensure Services are Free

Sometimes preventive care can come with a charge, so it is important to know how to avoid charges and continue to receive care for the least amount of money as possible. Firstly, grandfathered plan members should read their schedule of benefits, or consult their employer or insurer as to any changes that may have been made since the ACA’s inception. Secondly, make sure if you do have a plan that offers free preventive care, that you use providers within your plan’s network. Non-network doctors and facilities are seldom covered at 100 percent for preventive care, so it is best to use your own network. Another issue is that occasionally, you will get charged for a test that was run during your preventive exam. If the reason for your visit is not solely for prevention, you may likely expect a bill.

Also, some services considered a preventive service may not be charged as such under the circumstances of a patient feeling symptoms of a condition or illness. An example of this is if you suspect a lump in your breast, and go in for a mammogram. The claim would be filed as a diagnostic procedure in that case. Understanding how care is billed is crucial to policyholders, and helps keep your costs and confusion to a minimum.

Preventive services are issued based on a person’s age, gender, medical history, and predisposition to health risks. Some services may be covered for certain individuals and not others until they reach a specified age. To find out which services are covered for you, contact your primary care provider, or a physician in your network. You should receive each recommended service, from routine physicals to cancer screenings, and more, depending on your health. Your insurer may also be able to tell you which services are available to you and your family.