You see it advertised. You hear it from your doctor. It’s mentioned in mail from your insurance company. But what is preventive care anyway? What’s included? And how much will it cost you?
There’s a lot of confusion around what is and isn’t preventive care – and why it matters. Here’s what you need to know.
What is preventive care and why is it important?
Preventive health care is the stuff you do (before you get sick) to stay healthy. So why should you go to the doctor when you’re healthy? The simple answer is that preventive care can help you stay healthier and, as a result, lower your health care costs.
For example, immunizations are considered preventive care. That’s because vaccines help protect you and those around you from diseases like tetanus, measles, chicken pox, seasonal flu and COVID-19.
But preventive care can also help identify health problems like high blood pressure, diabetes or certain cancers earlier, when they’re most treatable. Of course, tackling health issues early helps you get or stay on a healthy track, and reduces the risk of developing other health conditions.
Preventive health care examples
What’s considered preventive care you may ask? Examples of preventive care services include:
- Your annual checkup – In addition to a physical exam, your annual checkup can include important general health screenings for high blood pressure, cholesterol and other health conditions.
- Cancer screenings – Most people don’t experience cancer symptoms when diseases are in their earliest, most treatable stages. That’s why screenings are recommended at certain times and intervals throughout your life. For example, it’s recommended that both men and women begin colorectal cancer screenings starting at age 45. Other preventive screenings for women include Pap tests and mammograms. For men, prostate specific antigen (PSA) tests to screen for prostate cancer might be recommended.
- Childhood immunizations – Immunizations for children include hepatitis A and B, chickenpox, and measles and MMR (mumps and rubella).
- Adult immunizations – These include Tdap (tetanus, diphtheria and pertussis) boosters, and immunizations against pneumococcal conjugate and shingles.
- Your yearly flu shot – Flu shots can help reduce your risk of getting the flu by up to 60%. And if you do happen to get the flu, having the flu vaccine can significantly reduce the chances of serious flu symptoms that could lead to hospitalization.
The best part? Most preventive care services won’t cost you a penny
A ton of preventive care services are folded into what you already pay for your health insurance – so you won’t pay a single extra cent for it. Most health plans are required, by law, to cover eligible preventive services at 100%.
That means no out-of-pocket costs for you, as long as you get preventive care services from a doctor or clinic your plan covers. By “no cost”, we mean:
- You pay nothing to visit the doctor (copays)
- No sharing the cost of your care with your plan (coinsurance)
- No amount you have to pay yourself first before your plan helps (deductible)
Yep, that’s right. You just need to find a doctor that’s covered by your plan.
What’s not considered preventive care?
Remember, preventive care happens before a problem is identified. So, the same service may or may not be considered and billed as preventive care, depending on your health situation.
For example, if a person gets a colonoscopy as a colorectal cancer screening, that’s preventive – even if the doctor removes polyps or tissue samples during the procedure. But if additional follow-up care is needed – such as another procedure to remove additional growths or any treatments if cancer is detected – it is not considered preventive, so you may have some out-of-pocket costs.
Non-preventive care examples:
- Primary care office visits related to a specific health care need such as the common cold or flu, seasonal allergies, rashes or minor injuries.
- Certain appointments with specialty doctors such as dermatologists, allergists or cardiologists, depending on your insurance coverage.
- Diagnostic tests and screenings to learn more about a suspected or known medical condition
If you're not sure if something is considered preventive for you, contact your insurance company. Do you have HealthPartners insurance? Check your insurance coverage.
Get those freebies (and improve your health) with preventive care
Preventive care is important for your overall health and well-being, helping keep you healthier and identifying problems earlier.
If you’re not sure what preventive care you’re due for, get in touch with your primary care clinic or doctor. Your online account through your health insurance company should also have information and reminders.
Don’t know whether the appointment you want to make is preventive or not? Contact your insurance company and ask about your coverage.