What Is Preventive Care?
Most medical plans cover preventive services that come at no cost to the patient. But what is preventive care? What are the specific preventive care services for women, men and children?
To answer your questions, we’ve compiled some preventive care guidelines so you can know what plans may be available to you, the services you may want to include in your care plan and what costs you may face.
According to the Centers for Disease Control (CDC), seven out of every 10 deaths among Americans every year are due to chronic diseases, of which many are preventable. By using preventive care, many Americans can stop these illnesses before they become major health problems.
What Is Preventive Care?
Preventive care refers to services intended to prevent illnesses before you feel sick or become aware of any symptoms. The purpose of preventive care is shifting the focus for patients from treating illnesses to maintaining good health and wellness.
Preventive care can help keep you healthy longer by preventing or delaying the onset of diseases. Preventive care can also help you save you money because you won’t have to treat a costly illness. If you want to make your health a priority, learning about and using preventive care is a great place to start.
What Is Included in Preventive Care?
In a medical setting, preventive care includes immunizations, screenings, counseling, lab tests, annual checkups and other services. In your everyday life, preventive care can include exercise, diet and a healthy lifestyle. A healthy lifestyle can mean giving up unhealthy behaviors, such as drinking or smoking.
These screenings are commonly covered:
- Blood pressure
- Hepatitis B
- Hepatitis C
- Type 2 diabetes
- Lung cancer
- Sexually transmitted diseases
Counseling may also be accessible for people who wish to quit smoking, stop abusing alcohol, prevent cardiovascular disease or fight obesity.
Some common immunizations can also be covered. These immunizations typically include:
- Hepatitis A
- Hepatitis B
- Whooping cough
4. Preventive Care for Adults
Many health plans cover a list of preventive services for adults without coinsurance or copayments. Some of these general preventive services for adults include:
- Aspirin useb: This service is to help prevent colorectal cancer and cardiovascular disease.
- Counseling for dietb: This service is for adults who are at higher risk for a chronic disease.
- Prevention counseling for STIsb: This counseling is for adults who are at higher risk for sexually transmitted infections.
- Preventive medication for statinb: This service is for adults who are between the ages of 40 and 75 and at higher risk.
- Prevention of fallsb: This service is for adults who are 65 years of age or older and live in a community setting. This service is performed using physical therapy, exercise and vitamin D.
- Screening and counseling for alcohol misuseb: This service is for adults who are misusing alcohol.
- Screening and counseling for obesityb: This service is for adults who are obese or at risk of becoming obese.
- Screening for Hepatitis Cb: This service is for adults who are at higher risk and a one-time service for adults who were born between 1945 and 1965.
- Screening for HIVb: This screening is for adults up to age 65 and those at higher risk.
- Screening for lung cancerb: This service is for adults between the ages of 55 and 80 who have a high risk of lung cancer. This higher risk is due to being a heavy smoker or quitting smoking in the last 15 years.
- Screening for syphilisb: This screening is for adults who are at higher risk.
- Screening for type 2 diabetesb: This service is for adults who are between the ages of 40 and 70 and are overweight or obese.
- Screening for tobacco useb: This service is for all adults and for tobacco users who want cessation intervention.
There are also preventive care services specifically for women and services specifically for men.
5. Preventive Care for Women
Many health plans cover a list of preventive services specifically for women without coinsurance or copayments. Some of the preventive services for women include:
- Chemoprevention counseling: This service is for women at higher risk for breast cancer.
- Counseling for sexually transmitted infections: This service is for women who are sexually active.
- Genetic test counseling: This service is for women at higher risk for breast cancer.
- Mammography screenings: This service screens for breast cancer and offered every one to two years for women over the age of 40.
- Screening and counseling for HIV: This service is for sexually active women.
- Screening for cervical cancer: This Pap test, also known as a Pap smear, is offered to women between 21 and 65 every three years. Alternatively, every five years, women can combine a Pap smear and an HPV DNA test if they are between 30 and 65. This alternative is for women who don’t want to get a Pap smear every three years.
- Screening for chlamydia infection: This service is for younger women and women at a higher risk for chlamydia.
- Screening and counseling for domestic and interpersonal violence: This service is for women who may be facing domestic violence.
- Screening for diabetes: This service is for women who have a history of gestational diabetes but are not currently pregnant and have not been previously diagnosed with type 2 diabetes.
- Screening for gonorrhea: This service is for women who are at a higher risk of contracting gonorrhea.
- Screening and interventions for tobacco use: This service is for women using tobacco products.
- Screening for osteoporosis: This service is for women over the age of 60, depending on their risk factors.
- Screening for Rh incompatibility: This service is follow-up testing for women who are at a higher risk.
- Screening for syphilis: This service is for women who are at a higher risk.
- Screening for urinary incontinence: This service is offered for women annually.
- Well-woman visits: This service is recommended for women who are under the age of 65.
There are also preventive healthcare services specifically for women who are pregnant or may become pregnant, including:
- Contraception: This includes FDA-approved contraceptive methods, patient education, patient counseling and sterilization procedures prescribed by health care providers for women with the capacity for reproduction. Health plans sponsored by certain religious employers are exempt.
- Counseling and comprehensive support for breastfeeding: This service is from trained providers and provides access to breastfeeding supplies for both pregnant and nursing women.
- Counseling and intervention for tobacco use: This service is for tobacco users who are pregnant.
- Folic acid supplements: These are for women who may get pregnant.
- Screening for anemia: This service is offered on a routine basis.
- Screening for gestational diabetes: This service is for women who are 24 to 28 weeks pregnant and women who are at high risk for developing gestational diabetes.
- Screening for Hepatitis B: This service is for pregnant women during their first prenatal visit.
- Screening and prevention for preeclampsia: This service is for pregnant women who have high blood pressure.
- Screening for Rh incompatibility: This service is for all pregnant women. It also includes follow-up testing for higher risk testing.
- Screening for urinary tract infection: This service is for women who have a urinary tract infection or other similar infections.
6. Preventive Care for Men
Many health plans also cover preventive services specifically for men without coinsurance or copayments. Some of the preventive services for men include:
- Screening for abdominal aortic aneurysm: This is a one-time screening for men of certain ages who have smoked.
- Screening for blood pressure: High blood pressure can increase the risk of stroke, heart attack and kidney damage.
- Screening for cholesterol: High cholesterol is one of the main factors that affect the risk of heart disease. Men with a family history, health history or lifestyle factors that could contribute to their risk should be screened regularly.
- Screening for colorectal cancer: This screening is for men between the ages of 50 and 75.
Men should visit the doctor for preventive checkups every three to five years if they’re healthy. Young men who have a medical condition, a family history or live a high-risk lifestyle should visit the doctor every year. Men who are 50 or older should visit the doctor every year or every two years, or more often if they have a chronic medical condition.
7. Preventive Care for Children
Many health plans also cover a list of preventive healthcare services specifically for children without coinsurance or copayments. Some of the preventive services for children include:
- Assessments for tobacco, drug and alcohol use:This service is for adolescents who may be using any of these substances.
- Assessments of behavior:These assessments are for children from birth to 11 months, 1 to 4 years old, 5 to 10 years old, 11 to 14 years old and 15 to 17 years old.
- Developmental screening:This service is for children under the age of 3.
- Fluoride varnish:This is for infants and children when their teeth are present.
- Immunizations:These are for children from birth to 18. Vaccines include tetanus, diphtheria, whooping cough, Hepatitis A, Hepatitis B, influenza, HPV, rotavirus, measles and chickenpox.
- Measurements for weight, height and BMI:These measurements are for children from birth to 11 months, 1 to 4 years old, 5 to 10 years old, 11 to 14 years old and 15 to 17 years old.
- Preventive medication for gonorrhea:This service is for newborns’ eyes.
- Risk assessment for oral health:This service is for children from birth to 11 months, 1 to 4 years old and 5 to 10 years old.
- Screening for autism:This service is for children 18 months to 24 months old.
- Screening for bilirubin concentration:This service is for newborns.
- Screening for blood pressure:This service is for children from birth to 11 months, 1 to 4 years old, 5 to 10 years old, 11 to 14 years old and 15 to 17 years old.
- Screening of blood:This service is for newborns.
- Screening for cervical dysplasia:This screening is for girls who are sexually active.
- Screening for depression:This service begins routinely at the age of 12.
- Screening for dyslipidemia:This service occurs once when children are between the ages of 9 and 11 and once more when they are between the ages of 17 and 21. This screening is also for children who are at a higher risk of a lipid disorder and are between the ages of 1 to 4, 5 to 10, 11 to 14 and 15 to 17.
- Supplements for fluoride chemoprevention:This service is for children who don’t have fluoride in their water.
- Screening for hearing:This screening is performed for newborns and performed once for children between the ages of 11 and 14, once between the ages of 15 and 17 and once more between the ages of 18 and 21.
- Screening for hemoglobin or hematocrit:This service is for all children.
- Screening for sickle cell or hemoglobinopathies:This service is for newborns.
- Screening for Hepatitis B:This service is for adolescents who are at high risk. This includes adolescents born in the U.S. who were not vaccinated when they were infants and have a parent who was born in a region with a prevalence of Hepatitis B of 8% or adolescents who are from countries with a Hepatitis B prevalence of 2% or more.
- Screening for HIV:This screening is for adolescents who are at higher risk.
- Screening for hypothyroidism:This service is for newborns.
- Supplements for iron:These are for children between 6 and 12 months who are at risk for anemia.
- Screening for lead:This service is for children who are at risk of exposure.
- Screening for obesity:This service can also include counseling for obesity.
- Screening for PKU:This screening is for newborns and refers to phenylketonuria.
- Screening and prevention counseling for STIs:This service is for adolescents who are at higher risk for sexually transmitted infections.
- Screening for vision:This service is for all children.
- Testing for tuberculosis:This service is for children who are at higher risk.
To determine what type of preventive care plan you should have, start here and then talk to your doctor about what’s right for you.
What Are the Benefits of Preventive Care?
Preventive care offers significant benefits for patients.
1. Extends Life Expectancy
Preventive care has been known to increase life expectancy significantly, especially for people age 30 to 49. Tests and screenings can often catch diseases before they become a major health problem, thus allowing patients to begin treatment or make changes to their lifestyle while the illness is still in its early stages or before it even starts.
This means preventive care helps you maintain your health.
2. Avoid Symptoms of Chronic Diseases
By catching diseases and illnesses early or preventing them from manifesting altogether, you’ll avoid the painful and uncomfortable symptoms that accompany chronic diseases.
3. Treatment Is Easier
For chronic diseases, catching them in the early stages makes treatment easier and more manageable. Early treatment can also lead to faster recovery time.
4. Ability to Be Active
Being active can be difficult when you’re managing an illness or a chronic disease. By preventing the contracting of these diseases, you can be more active in your everyday life.
5. Saves You Money
Many preventive services are also completely covered by insurance, meaning you won’t have to pay any out-of-pocket costs for preventive care if you have health insurance. Make sure you see a doctor in your plan’s network to receive these services for free.
You will also be lowering your long-term costs for managing a disease because diseases caught in the early stages tend to be easier to treat.
Combining preventive care services with a wellness-focused lifestyle can lead to significant savings.
6. Saves America Money
The U.S. spends more money on healthcare than any other country in the world. Yet the lifespan of Americans is lower than citizens in countries that spend less on healthcare every year.
The CDC reports that more than 75% of this spending is on Americans who have chronic conditions. By using preventive care, Americans can decrease the damage caused by chronic diseases and lower the costs incurred from the treatment of those diseases. If preventive care doesn’t increase in the U.S., then healthcare costs could continue to rise and American life expectancy will remain shorter than those in other nations.
When it comes to medical care, the best thing you can do for your health and your wallet is to prevent illness in the first place. Preventive care does just that by improving your health for many years and maybe even saving your life. If you’re wondering how you can improve the quality of your health, preventive care is where you need to start.
How Does Preventive Care Relate to Health Insurance?
Preventive care actually lowers the cost of healthcare by stopping diseases before they become more serious, and thus, much more expensive. Healthcare costs can plummet Americans into debt, and maybe even bankruptcy. Health problems can also force people to retire early, meaning they have less money to contribute to their healthcare expenses.
Hospital care accounts for a third of total healthcare costs in America, so by preventing visits to the emergency room, Americans can save a lot of money that would otherwise be spent on medical costs. Unfortunately, many Americans use the emergency room as if it were their primary care physician. If you’re uninsured, the cost of going to the emergency room can be huge.
The four leading causes of death are cancer, heart disease, stroke and chronic obstructive pulmonary disease, all of which are preventable. Stroke and heart disease are typically caused by obesity and poor nutrition. Lung cancer is caused primarily by smoking and obesity can be a risk factor for other forms of cancer.
These diseases are expensive to treat, even before emergency room costs. Many of these costs can be out-of-pocket. Patients grow tired of taking medications or believe they can no longer afford them, and then they end up in the emergency room after a stroke, heart attack or other health complications.
Preventive care can significantly lower healthcare costs in America by preventing Americans from contracting these diseases. If health insurance covers preventive care and makes these services free for patients, Americans can cut their healthcare costs.
Get Free Preventive Care
By developing a consistent exercise routine, eating a healthy diet, avoiding unhealthy behaviors and visiting the doctor regularly, you can enjoy the benefits of preventive care.
To make sure your preventive care is free:
- Schedule an appointment with an in-network provider
- Say your appointment is for your free annual preventive care exam when you schedule it
- Request that your doctor codes the service as a visit for preventive care
Visit us online at Health For California for more information about free preventive care.