Preventive Care: What’s Covered and What’s Not

Thanks to the Affordable Healthcare Act, all healthcare plans are required to cover preventive doctor’s visits and exams, meaning you won’t have to pay a deductible, copay, or coinsurance after your appointment.

What exactly is preventive care?

Preventive care is any health care service that helps prevent or detect medical problems before they become severe. Services like these include your annual check-up, routine tests and screening, and flu shots, for example. However, it’s important to note that the list of preventive care services differs for three groups: adults, women, and children.

What are the benefits of preventive care?

Besides helping you stay as healthy as possible for free, preventive care helps:

● Increase your lifespan

● Prevent infections

● Reduces the severity of disease and illness

What health care services are considered preventive care for adults?

Here’s a list of some standard services that must be provided free of charge if recommended by your doctor:

● Flu shot. 1 shot per calendar year, which helps protect you against the flu virus, is covered.

● Vaccinations. Vaccinations for COVID-19, measles, tetanus and other common diseases are covered 100%.

● Annual check-up. Including 1 per calendar year, the annual check-up is when your doctor checks your overall health to help detect medical issues before they become severe.

● Mammogram. It’s recommended to receive 1 per calendar year after the age of 40. This routine exam uses an X-ray to check the breast tissue for signs of abnormalities.

● Colonoscopy. It’s recommended to receive 1 every 10 years after the age of 50 to screen for colon cancer.

● Screenings. Prevent infectious diseases with common screenings for medical problems such as HIV or diabetes.

You can find a complete list of preventive services on the U.S. Preventive Services Task Force’s website here. Some examples of services that aren’t included are:

● Specialist visits. If you need to see a particular doctor like a neurologist or dermatologist, this is not included in preventive care.

● Alternative wellness. Acupuncture, chiropractors, and other alternative therapies are not included.

● Additional doctor’s visits. If you need a follow-up visit to the doctor for a particular problem, this is not included.

When should you receive preventive care services?

You can consult with your doctor to determine the best timeline or plan for receiving your recommended preventive care. Asking your doctor about what’s best for you is a good practice because they can review your family and personal health history and background and make well-informed recommendations.

The bottom line

These necessary preventive care services are provided to you and your family free of charge just as long as you see a healthcare provider that is in-network. It’s essential to take advantage of these services, as they can help you prevent further health problems (and medical bills) down the line.