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Preventive care 101: what, why and how much

What is preventive care anyway? What’s included? We’ll break it down for you.


By Katie Sahnow
July 28, 2017

     


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?

As a member services representative I know there’s a lot of confusion around what is and isn’t preventive care. It can be confusing! Here’s how I explain it.

What’s preventive and why does it matter?

Routine preventive care is stuff you do – before you’re sick – to keep yourself healthy. You get a flu shot to help avoid the flu. You get your cholesterol checked to make sure it’s not high enough to make you sick. You get a colonoscopy so if anything looks abnormal, you can have it taken care of before it gets worse. Not only does preventive care keep you feeling great, help you avoid getting sick and catch problems before they’re bigger problems – but it also means you’ll use less care that costs you money in the long run.

Once, a member called us with a question about setting up a doctor's appointment. After working through her question, we noticed she hadn't set up her regular mammogram. We encouraged her to make an appointment, since it was recommended she get a mammogram at her age. Afterwards, we found out the member was diagnosed with breast cancer, something she may not have discovered if she hadn't taken the time to make an appointment and get her preventive care.

Most won’t cost you a penny

Not convinced? What if I told you a ton of preventive care is folded into what you already pay for your health insurance – so you won’t pay a single extra cent for it? The new health care law says all health plans* have to cover many preventive services at 100 percent.

That means no out-of-pocket costs for you, as long as you get them from a doctor or clinic your plan covers.

By no cost I 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 visit a doctor that’s covered by your plan. Here’s how to check.

Related contentCo-what? Copays, coinsurance and the other stuff that comes out of your wallet

When it’s not preventive care

The same service – like getting your blood pressure checked – may or may not be considered and billed as preventive care, depending on your health situation. Remember preventive care happens before a problem is identified.


Here’s an example:

So if your doctor checks your blood pressure during a regular checkup to make sure it’s normal, that’s preventive.

But if you tell your doctor about symptoms you’re having (the problem) then prompt him or her to check your blood pressure, that’s not preventive.


Any other tests your doctor orders aren’t considered preventive. When you come back in a couple months to see if your new medication is working, your blood pressure check isn’t preventive. Your insurance will probably cover part of this, but you will probably have to pay a co-pay (a fee you pay each time you go to a doctor) or co-insurance (a percentage of the charges).

Good news – some health insurance companies are going above and beyond and covering more than what’s required under the new health care law.

HealthPartners members: Click here to see what’s covered for you.

Get those freebies

If you’re not sure what preventive care you’re due for or if your appointment is preventive or not, log onto your health plan’s online account for reminders. Or call your insurance company to find out what preventive care is covered for you or your kids this year.

If you're not sure if something is considered preventive for YOU, call your insurance company and ask!

HealthPartners members: Click here to see what’s recommended for you.

*The one exception is “grandfathered” plans – or certain existing health plans that haven’t changed in several years – and do not have to cover all preventive care services. Your employer has to tell you if your plan is grandfathered, but if you’re not sure, call and ask.

About Kate Sahnow

Kate Sahnow is a HealthPartners Member Services leader supporting MNsure members through phone calls, email, chat, and walk-ins. She extends this support by writing for the Health Insurance Help blog. Connecting members to support programs so they can achieve their best health is what makes her job so rewarding. Outside of work, Kate loves spending time with her husband, son Ethan, and daughter Cora. They are passionate about sustainability, own two electric vehicles, and enjoy taking yearly vacations to Ely, Minnesota.

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