Your physician emphasizes the importance of having it. Renowned medical experts go on live television programs extolling its virtues. Even your health insurance company stresses the importance of it for your health insurance policy. Yet, you are not sure what it really means.
What is preventive care and does my health insurance cover the cost?
In the broadest sense, preventive care covers actions such as diet, nutrition, exercise, and following healthy habits such as not smoking. For insurance policies, preventive care represents the actions you take to prevent an illness or a disease from negatively impacting your life. For example, getting an annual screening for breast or prostate cancer is considered preventive care in the eyes of health insurance companies, Another example is the vaccines approved to prevent the development of healthcare issues such as measles and chickenpox.
Preventive care also involves completing tests that indicate areas that you need to focus on to ensure optimal health. A prime example is testing for blood pressure at least one time a week. The key is to discover the development of a health issue in its earliest stage to keep your life on a healthy track, while lowering the cost of your healthcare.
Is There a Difference Between Preventive and Diagnostic Care?
Most health insurance policies distinguish between preventive and diagnostic care. Preventive care represents the first step in identifying a potential healthcare issue, while diagnostic care is the step that confirms the results of a preventive test or screening. For example, a physician might discover a lump on the breast of a patient by completing a general physical examination. To verify the presence of a breast tumor, the physician refers the patient to visit a radiologist who conducts a mammogram. The first and follow-up mammograms are considered diagnostic care that follows preventive care.
What are Common Examples of Preventive Care Services
Preventive care services vary in frequency. An annual check-up occurs when your primary healthcare provider conducts a thorough physical examination to discover any early signs of the development of a disease or illness. The one visit per calendar year preventive care service represents the most common type of preventive care written into health insurance policies.
Covered under most health insurance policies, an annual flu shot is a type of preventive care that protects you from specific flu virus strains that change from one year to the next year. One mammogram a year, which typically starts after a patient turns 40 years old, represents a basic x-ray of breast tissue to detect any signs of tumor growth or another type of abnormality. Some health insurance plans cover the type of preventive care called 3D imaging.
Vaccinations, which are usually administered during childhood, prevent the development of diseases such as mumps, measles, rubella, and polio. Other types of vaccinations include hepatitis A, hepatitis B, tetanus, and chickenpox. As a less frequent type of preventive care, a colonoscopy screens for tumors in the colon at a rate of one time every 10 years.
What is Considered Non-Preventive Care Services?
Diagnostic tests are not considered routine screening that health insurance policies cover as preventive care. If you undergo more than one physical examination per year, your health insurance policy will not define the additional physical examinations to be preventive care visits. For instance, let’s assume you received an annual physical examination in March and one month later, you develop flu symptoms. The second visit with your physician to treat flu symptoms is not considered a preventive care visit. Visits with specialists, such as a podiatrist, neurologist, or oncologist, are not covered as a preventive care service.
Some health insurance policies cover a PSA blood test for screening the development of prostate cancer, but a vast majority of health insurance plans do not cover the test. Alternative therapies like massages and acupuncture are not considered preventive care services as well.
Is Preventive Care Free?
Health insurance companies include preventive care services in the annual premium that you pay for a policy. This means an annual visit with your physician for a physical examination should not cost you a dime. According to state and federal law, health insurance companies must cover qualifying preventive care services at a 100 percent rate. You should no have to pay out-of-pocket costs for approved preventive health care services.
You should not have to pay anything from a copay arrangement, as well as share the cost of your medical care under a coinsurance policy. In addition, your health insurance policy should not make you dip into the annual deductible to pay for eligible preventive care services.
Preventive Care: Good for Your Wallet, Good for Your Health
Despite the financial benefits of preventive care services, the most important benefit is detecting medical conditions and potential healthcare issues before they start to diminish the quality of your life. Preventive care is good for both your health and your bank account.
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