What Is Preventive Care?

Preventive care can help you stay healthy, avoid or delay sickness, or manage a condition you currently have. You can choose to leverage preventive care as part of your health plan at any stage of life. Preventative care can give you and your family the option to save more and opens up more choices about what you want to do now and in the future.

What Does Preventive Care Focus On?

Having preventive care in your health insurance plan gives you a running start on living the lifestyle you want. It may include:

  • Regular check-ups
  • Screenings for every life stage
  • Age-appropriate immunizations

Preventive care can preempt spending on medical care and services, by strengthening your body against preventable conditions, diseases or possible complications. By leveraging preventive care, you give yourself more freedom to live how you want to.

How Does Preventive Care Support Your Health Insurance Plan?

Preventive care helps you know your state of health, so medical professionals can advise you how best to choose the lifestyle you want. Doctors can perform appropriate screenings for your life stage, help you manage short-term health challenges, and advise you on how to protect yourself against preventable diseases.

Your health insurance plan can include two parts:

  • Preventive care benefits
  • Medical benefits

Preventive care benefits may cover the screenings, tests, and immunizations recommended by the United States Preventive Services Task Force (USPSTF). Medical benefits may cover other tests and screenings that may be recommended by your doctor or health professional. Our preventive service guidelines can help you decide with your doctor what the right health screenings are for you and your family. You can be 100% covered for preventive care benefits under certain medical plans.

What Is Not Considered Preventive Care?

If your health insurance plan covers both your preventive care and medical benefits, you can be advised to take tests and screenings that fall under your medical benefits instead of preventive care. If you are being treated for an existing condition or are presenting symptoms of an illness when you visit, tests and check-ups may fall under medical benefits. These tests or treatments may be subject to deductibles, copays or coinsurance.

Member Example

Kelly, age 45, sees her doctor for a routine office visit. During her annual physical, she also has age-appropriate screenings. Her doctor orders a lipid screening, urinalysis, and full blood chemistry panel. The office visit and lipid screening are part of the USPSTF recommendations. Kelly’s preventive services benefit covers them 100%.

However, the urinalysis and full blood chemistry panel are not part of the USPSTF recommendations. Instead, they are covered under Kelly’s medical benefit, as outlined by her medical plan design. She is subject to any copay, deductible, or coinsurance under her plan.