Importance of Reviewing a Health Plan’s Preventive Care Services

Affordable preventive care is a necessary aspect of health care, though many people still go without it. Whether you’re looking for new insurance or reviewing your current plan, it’s crucial to understand the importance of reviewing health plans’ preventive care services before selecting a plan. Every health insurance plan is different — different rules, different coverage and different prices — even when it comes to preventive care.Find out what preventive care is and why reviewing your preventive care services is important.

What Is Preventive Care?

Preventive care includes healthcare services and procedures that are intended to prevent illness, injury or disease. The goal here is to catch and treat smaller health conditions before they become serious health risks. The Patient Protection and Affordable Care Act (PPACA) mandates preventive care be free on most healthcare plans to help remove cost barriers and make essential care available to everyone.

Free preventive care means the eligible services aren’t subject to your deductible and there won’t be copays for them. However, there are some exceptions. For example, if your healthcare plan is grandfathered or isn’t regulated by the PPACA, like short-term plans, or if a doctor isn’t in your network, preventive care may not be free.

So what counts as preventive care? The following treatments typically count:

  • Doctor’s visits, like wellness checkups
  • Allergy medications
  • Immunizations
  • Insulin
  • Contraception
  • Screenings for conditions like high blood pressure or skin cancer
  • Mammograms and colonoscopies

There are extensive lists of preventive care treatments specifically for childrenwomen and adults in general. Over time, these lists are subject to change, and healthcare providers may provide additional services that aren’t covered under preventive care. Be sure to communicate with your healthcare provider and insurer.

What Are the Preventive Care Guidelines?

You may notice that some preventive care services are missing from the lists. So, how do services get added to the lists of other covered services? For a healthcare service to be classified as preventive care, it must meet at least one of three guidelines:

  1. The Advisory Committee on Immunization Practices (ACIP) for the Centers for Disease Control and Prevention (CDC) recommends the service.
  2. The United States Preventive Services Task Force recommendations rate the service either “A” or “B.”
  3. The service is listed in the Health Resources and Services Administration’s (HRSA’s) comprehensive guidelines.

Every preventive care service meets one or more of these guidelines. As the guidelines change, so will the lists of eligible preventive care services. For example, vitamin D screenings aren’t currently on the list of covered preventive care services. Currently, there isn’t enough research for medical experts to recommend it be on the list. If you don’t see a preventive care service on the list, it’s likely for similar reasons.

Why Reviewing Preventive Care Is Important

So why review preventive care services before choosing a health plan? Understanding preventive care coverage is essential because:

Not Every Insurance Covers It

Because there are some instances where insurance may not cover preventive care services, reviewing your plan is crucial so you know what’s covered and what the stipulations might be.

In addition to understanding your health plan’s limitations and coverage when it comes to preventive care, reviewing your plan allows you to ensure you’re getting access to these services at no cost. Having access to preventive care services helps you stay healthy and prevent health issues from becoming serious problems.

You Can Detect Issues Early

Without free preventive care, many people wouldn’t see a doctor on a regular basis — only when dealing with a serious injury or condition. In many cases, conditions that become serious over time could have been detected early on with preventive care.

For example, without preventive care coverage, many cancers and diseases would go undetected until they’ve progressed into difficult or impossible to treat conditions. However, with annual preventive care screenings and tests, there is a higher chance of catching diseases while they’re still treatable.

Chronic diseases like cancer, heart disease, lower respiratory disease and strokes are preventable and more manageable with regular access to preventive health care. Conditions like these are expensive to treat, even if they’re caught before a hospital visit. Without preventive care, many patients can’t afford the necessary doctor visits, treatments, medications and screenings associated with these conditions. When this happens, more often than not, the patient will cut back, which leads to hospital visits with serious complications.

Preventive care makes discovering and managing these conditions more likely and more affordable. When health problems are treated early on, patients can avoid the emergency room, thus reducing the cost of health care.

You Can Stay Healthy

In addition to lowering healthcare costs, preventive care keeps people healthy, allowing them to stay active and work for longer. Without preventive care, you’re more likely to have poor health, especially as you age.

For many people, this leads to early retirement because their poor health keeps them from being productive. Many people are also unable to enjoy the same activities or hobbies they once did because of their health conditions. Preventive care can give you a chance to continue enjoying an active and working lifestyle longer into your life.

Because this care is beneficial in so many ways, you should be sure to review your health plan for information on preventive care. This is especially true if you’re uninsured and looking for a health plan or are looking to switch plans because you don’t want to get stuck with insurance that doesn’t give you the necessary coverage.

When Preventive Care Might Not Be Covered

There are a few situations where your insurance provider may not cover 100% of preventive care services. It’s important to review your health plan so you know when something may not be covered to help you avoid surprise costs. Here are some of the most common reasons your insurance provider may not completely cover preventive care services.

1. Grandfathered Health Plans

Grandfathered health plans are exempt from certain regulations under the Affordable Care Act (ACA). Grandfathered plans are ones that were already in place when the ACA went into effect in 2010. Because these plans were already in place at the time of the new laws, they’re allowed to remain as they were, though the plans cannot be changed and they can’t be purchased anymore.

Because of these limitations, grandfathered health plans are becoming less common as time passes and individuals and employers switch to new plans. However, many people still have grandfathered plans. Reviewing your plan or talking to your provider’s customer service team are great ways to learn the status of your plan and determine if preventive care is covered.

2. Provider Networks

Many insurance providers have contracts with healthcare providers that state they’ll provide discounted care to those with said insurance plans and accept that price as full payment. The group of healthcare providers that an insurance company partners with becomes their provider network.

If you go to a healthcare provider within your health plan’s network, your preventive care will typically be covered. However, your insurance provider can charge you for preventive care if you go to a healthcare provider outside of the network.

3. Excepted Benefit

In some states, certain health plans are considered an excepted benefit, which means the ACA doesn’t regulate these plans. Without ACA regulation, these health plans can choose to either partially cover or not cover preventive care at all. This often includes short-term health plans, sharing ministry plans, Farm Bureau plans and fixed indemnity plans.

4. Preventive vs. Diagnostic

Some preventive care services are also used to diagnose a problem. For example, if you go to the doctor to discuss a current illness or new medical concerns, your visit might be considered a treatment visit instead of preventive care. Appointments that are problem-focused and used to address diagnoses typically won’t be covered as preventive care like a visit for reviewing histories, medications and performing routine screenings would be.

How to Avoid Extra Costs

Going to the doctor and leaving with an unexpected bill can be frustrating. Luckily, there are a few ways to help ensure there are no surprises on your bill. Keep these tips in mind to help you avoid costs at your next preventive care visit:

  • When scheduling your appointment, specify that it’s for your annual preventive care exam, so you want tests and screenings that are 100% covered by insurance.
  • Ask if any treatments received during your visit aren’t considered preventive care.
  • Ask if the office will charge you for talking about health concerns that aren’t preventive care services.
  • Be sure to only visit in-network healthcare providers.
  • If there’s a costly treatment or service you need, ask various providers how they would bill the service before scheduling the appointment. In the same situation, talk with your health plan provider to find out how to get as much of the service covered as possible.

Also, keep in mind that while your preventive care might be free, your doctor’s office may bill you for the office visit. Always ask how they bill their appointments, and don’t be afraid to find a more cost-effective provider. If in doubt, ask around so you know exactly what you’re paying for.

Ways to Practice Preventive Care

In addition to checking your preventive services coverage, you can take charge of your health through other measures. Preventive care can consist of several different factors, and there are many ways you can practice preventive care to stay healthy and prevent future health concerns. By being proactive about your health, you can further save on healthcare costs.

Here are some things you can do to maintain your health, have an active lifestyle and practice preventive care.

Manage Your Weight

One of the biggest risk factors for chronic diseases like heart disease and diabetes is being overweight. One way to take preventive care into your own hands is to manage your weight. Getting regular exercise and eating healthy can help you lose weight and keep it off, which is crucial to maintaining a healthy weight.

However, many people find it difficult to stay motivated when trying to lose weight. Just know you’re not alone, and what works for one person may not be the answer for you and your health journey. Talk to your doctor about what they can suggest for you and your individual situation.

Get Mental Health Screenings

Mental health is an important part of health care that’s unfortunately often overlooked. Mental health can have a significant impact on other aspects of our lives, including eating habits, activity levels and stress levels, which can lead to various other health concerns.

Mental health disorders are also known to play a big role in substance abuse disorders ranging from drugs to alcohol. Substance abuse can lead to numerous health concerns. Mental health screenings for conditions like depression can help individuals get the necessary help before their mental health causes significant problems in other areas in their lives.

Get Physical Health Screenings

Physical health screenings available to you will depend on your age, gender and current and previous health conditions. For example, cervical cancer screenings are recommended for women ages 21-65. A different example is a Hepatitis B screening at a pregnant woman’s first prenatal appointment. Common physical health screenings include high cholesterol, cancers, diabetes and osteoporosis, among others.

These screenings allow you and your provider to catch health conditions while they’re still in the early stages and are easier to treat.

Stay up to Date on Vaccines

Vaccines are another form of preventive care that will depend on factors like your age and the recommended population for the immunization. Some common vaccines for adults include:

  • Shingles
  • Tetanus
  • Hepatitis A
  • HPV
  • Pneumococcal

Talk to your doctor about what vaccines you should get and when. Many healthcare providers also encourage seasonal flu shots because some populations of people are more susceptible to serious complications of the virus.

Schedule Annual Wellness Exams

Regardless of your health history or age, annual health exams are essential. This is when your healthcare provider screens for things like high blood pressure, cholesterol, weight and glucose levels. They’ll discuss your health history and ask if anything has changed. In many cases, wellness exams are when potential health concerns are screened for and detected if you have a condition.

Be sure to regularly schedule these appointments with your doctor to prevent serious health complications.

Find Affordable Health Insurance at Health for California Insurance Center

Finding affordable yet comprehensive health insurance can seem overwhelming. With so many options available to families, individuals and businesses, narrowing down your options to the best choice for your situation can be a challenge. At Health for California, we understand how difficult it can be to weigh all your options, and we can simplify it for you.

Tell us about yourself, and we’ll find the best insurance quotes from providers near you. We can offer various affordable plans to help you find the right option for you. Get a quote today or contact HFC for more information.

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