When buying insurance, oftentimes it makes sense to get a plan that covers preventative care rather than picking a plan with a huge premium.
In fact, if you tend to be quite healthy, getting a plan that doesn’t require a co-pay for preventative care can help you to avoid illness or even improve your health, so other services aren’t regularly necessary.
The problem is, it’s hard to define on your own what is considered preventative care. For example, if you get bloodwork because you’re at a new doctor and they want a better idea of your health history, that could be considered preventative, but if you have an illness and the blood work is to diagnose it, that isn’t preventative because you’re visiting the doctor while already ill.
If you don’t ask prior to your appointment and just assume something is preventative, you could end up leaving with a big bill you didn’t expect.
THE BASICS OF PREVENTATIVE CARE
It’s important to keep in mind that all health insurance plans are different and based on your age or gender, a service may not be deemed preventative, but this should give you a better idea of what qualifies as preventative service under health insurance.
These preventative services are typically available with no cost (typically dependent on age) for anyone with no co-pay for preventative insurance:
- Tests for blood pressure, cholesterol and diabetes
- Most cancer screening (this could include mammograms and colonoscopies)
- Counseling for various health topics like losing weight or reducing alcohol use
- Wellness checks for babies and children, up to age 21
- Routine vaccinations (measles, polio, meningitis)
- Pregnancy health counseling, screening and vaccines
- Flu and pneumonia shots
Some preventative services aren’t necessary for children, so they are only considered preventative for adults.
This includes screenings for alcohol misuse, blood pressure, cholesterol and depression. For adults over a certain age or who are at a higher risk, there is type 2 diabetes screening, abdominal aortic aneurysm screening (this is typically one time and for men who have smoked), colorectal cancer, HIV, obesity, syphilis and tobacco use screenings.
Immunization vaccines are important in preventing diseases, hence they are often considered preventative care. Some recommended vaccines are Hepatitis A, Hepatitis B, Herpes Zoster, Human Papillomavirus, Influenza, MMR (measles, mumps and rubella), Meningococcal, Pneumococcal, Tetanus, Diphtheria Pertussis and Varicella.
Some forms of counseling are considered preventative care, too. Counseling for alcohol misuse, diet (especially if you’re at a high risk for chronic disease), obesity and sexually transmitted infections prevention is all usually available for no co-pay.
For women, there are specific services that are considered preventative only for them – specifically because they are more likely to develop specific diseases or illnesses.
Much of the care for women is counseling-related. Breast Cancer Chemoprevention, BRCA counseling about genetic testing, and domestic or interpersonal violence are all areas that many insurance plans consider preventative.
Screenings that are usually considered preventative are Gonorrhea, HIV (Human Immunodeficiency Virus, cervical cancer screenings, Breast Cancer Mammograms (every couple years), Chlamydia Infection, Human Papillomavirus and Osteoporosis.
For pregnant women, preventative care includes a regular Anemia screening, Bacteriuria urinary tract infections, Hepatitis B screenings on a first prenatal visit, Gestational Diabetes screening, an Rh Incompatibility screening and follow-up testing and Syphilis screening. Support and counseling, as well as access to supplies, is available for women who plan to or are breastfeeding their children.
Women who may become or want to become pregnant also have access to folic acid supplements.
One of the main draws to having an insurance plan that covers preventative care is the coverage of contraception. The birth control must be Food and Drug Administration-approved, however any birth control can be costly for the user, and sometimes the cost of a plan that requires no co-pay for preventative care is worth the cost of the insurance plan.
Children’s preventative needs are different than those of adults.
Often times children are in need of more medical attention. When they’re at school they’re exposed to many germs and while playing with other kids they are more at risk for accidents that could result in broken bones or injuries to happen. Because of this, plans that concentrate on providing free preventative care rather than actual care for sickness or injuries aren’t as cost effective, however if this is what the child has, it’s good to know what parents can have checked out without stressing over the costs.
For young children to babies, there are Autism screenings, Congenital Hypothyroidisms screenings, developmental screenings, Gonorrhea preventive medication in newborns eyes, hearing screening, iron supplements, sickle cell screening and Phenylketonuria (for newborns) screening available.
Adolescents and older children can be screened or assessed for alcohol and drug use, Cervical Dysplasia, depression, Dyslipidemia (for kids at risk of lipid disorders), Hematocrit or Hemoglobin screening, HIV, obesity, tuberculosis, and vision.
Immunization vaccines are important for children and often are necessary to compete in sports, and attend daycare and school. The following immunizations for children are considered preventative: Diphtheria, Tetanus, Pertussis, Haemophilus Influenzae Type B, Hepatitis A, Hepatitis B, Human Papillomavirus, Inactivated Poliovirus, Influenza (Flu Shot), MMR (measles, mumps and rubella), Meningococcal, Pneumococcal, Rotavirus and Varicella.
Although vaccines aren’t necessary and some parents do not believe in giving children vaccines for various reasons, it is important to note that often times places that care or watch children will not allow children with no vaccination to attend so it’s important to speak with a doctor before deciding whether or not you want your child to receive a vaccination.
Overall, preventative services can help to keep you happy and healthy and this list is a helpful guide to understanding what insurance may cover. Be aware that plans are all different and can require you to pay for some costs of an office visit.
If the preventative service isn’t the sole purpose of the visit, costs may fall on you rather than your insurance provider. No matter what type of insurance you have, it’s always a good idea to talk to your health care provider to get a specific list of what services are or aren’t available as a free preventative service to you.
It’s also smart to keep in mind that a doctor may assume your insurance will cover a cost as preventative and tell you it won’t cost you money, however a doctor’s job is to treat you and they aren’t an expert on your individual insurance. If a doctor wants to perform a specific service, first call your health insurance company to consult before accepting that service so you aren’t hit with an unexpected doctor’s bill.