What is Considered Preventive Care?

Key Takeaways

Preventive care, or routine care, is health care that is provided to detect or prevent illnesses before they become major health problems, such as immunizations and annual check-ups.
Some examples of preventive services include diet counseling, certain medications, and screenings for cancer, diabetes, obesity, cholesterol, and HIV (human immunodeficiency virus).
Under the Affordable Care Act, private health plans, including plans sold through the Health Insurance Marketplace, are required to cover preventive services without imposing any cost-sharing on patients.

Most people avoid visiting a doctor unless they have serious health concerns. However, a preventive care visit, which is included in your health plan if you have health insurance, can catch health issues before they become serious and challenging to treat.

Please continue reading to learn about the different aspects of preventive services. We will also discuss the key differences between preventive and diagnostic care and whether a patient is required to pay for a preventive care visit.

What is classified as preventive care?

Preventive care, also called routine care, is health care that is provided to detect or prevent illnesses before they become major health problems. Immunizations and annual check-ups by your primary care provider are examples of preventive services.

Preventive care can save lives by identifying a disease early. It can improve health by treating an illness before it progresses to a more complicated condition. Preventive care is the most cost-effective measure in the long run to deal with diseases.

What is not considered preventive care?

Medical care is not considered preventive care when a diagnostic procedure is performed to look for something specific or treat a specific symptom or condition. For example, a routine mammogram for cancer screening is considered a preventive test. However, if the radiologist finds something suspicious on the screening mammogram and asks for a follow-up diagnostic mammogram or other forms of investigation, these follow-up tests will not be considered preventive care.

If a diagnosis of breast cancer is made and mammograms are done in the future to monitor the cancer or its response to treatment, these mammograms will not be considered preventive care services.

What are examples of preventive services?

Talk to your healthcare provider if you are interested in one of the preventive services. While the below lists are not comprehensive, here are some examples of preventive services for adults:

Screening and counseling for alcohol misuse and tobacco use
Aspirin for the prevention of heart disease
Obesity screening
Diet counseling
Blood pressure screening
Prediabetes and type 2 diabetes screening
Cholesterol screening
Preventive statin medication
Fall prevention in older adults
Screening for depression
Cancer screening, including colorectal cancer and lung cancer
Hepatitis B and hepatitis C screening for individuals with risk factors
HIV screening
Preventive HIV medication for high-risk individuals
Tuberculosis screening
Immunizations, including flu, chickenpox, measles, diphtheria, mumps, whooping cough, rubella, hepatitis A, hepatitis B, HPV (human papillomavirus), meningococcal, pneumococcal, tetanus, and shingles
Prevention counseling for sexually transmitted infections (STIs)

Preventive care for women includes:

Well-woman office visit
Bone density screening for women above 65 years of age
Genetic testing for breast cancer in women with risk factors such as a family history
Mammograms to detect cancer in breast tissue
Pap tests for cervical cancer screenings
Gonorrhea, chlamydia, HIV screening for women at high risk.
Urinary incontinence screening
Domestic violence screening
Birth control, including contraceptive methods and sterilization procedures
Preventive services during pregnancy, such as folic acid supplements, screening for gestational diabetes, screening for STIs such as gonorrhea and syphilis, screening for UTIs and other infections, hepatitis B screening, screening for maternal depression, preeclampsia screening and prevention, Rh compatibility testing, tobacco use counseling and interventions, and breastfeeding support and counseling

Preventive care for men includes:

One-time screening for abdominal aortic aneurysm in male smokers of a specified age
Prostate cancer screening with a PSA test for men between 55 and 69 years old.
Infectious disease screening
Lung cancer screening
Colorectal cancer screening
Diabetes screening
Cholesterol screening
Blood pressure screening
Eye exam
Dental exam

Covered services under preventive care for children include:

Well-baby and well-child office visit
CDC-recommended immunizations
Screenings for newborns, including bilirubin, blood, hemoglobinopathies, sickle cell screening, hearing, hypothyroidism, and phenylketonuria (PKU)
Gonorrhea prevention medicine for the eyes in newborns
Autism screening for children between 18 and 24 months of age
Behavior assessments and developmental screenings
Healthy weight, height, and body mass index (BMI) assessments
Blood pressure screening
Blood screening for hemoglobin and hematocrit
Oral health assessment
Fluoride supplements and fluoride varnish
Vision screening
Obesity screening
Cholesterol screening
Tobacco, alcohol, and drug use screening for teenagers
Depression screening in adolescents
STI screening and prevention counseling
Hepatitis B screening for teenagers at high risk
HIV screening and preventive medicine for adolescents at high risk
Lead screening for children at high risk
Tuberculin testing for children at increased risk of TB

Are preventive health services covered by insurance?

Under the Affordable Care Act, private health plans, including plans sold through the Health Insurance Marketplace, are required to cover preventive services without imposing any cost-sharing on patients, such as deductibles, copayments, or co-insurance. However, these benefits may not be fully covered by some grandfathered plans that were sold before the ACA came into effect in March 2010.

Eligible preventive care services under most health plans include immunizations, blood pressure screening, cholesterol screening, diabetes screening, diet counseling, fall prevention, cancer screenings, and prevention counseling for sexually transmitted infections, among others. Ask your doctor about the benefits available and how you can access them.

Certain tests and preventive services are offered only to people of certain ages and genders. For example, coverage for bone density testing is provided to women above the age of 65 years.

You should ensure the provider from whom you obtain a preventive service is in your plan’s network. Preventive services are free when they are obtained from an in-network provider, but they may not be covered if they are obtained from an out-of-network provider.

Note that a screening test is considered preventive. However, a follow-up test done if something is found on the screening test is not considered preventive and may not have health coverage.

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