What is preventive care and what services does it include? Preventive care is routine health care that includes screenings, checkups and patient counseling to prevent illnesses, disease or other health problems. Because of the Affordable Care Act (ACA), health insurers in the United States must cover certain preventive health care without requiring you to pay a deductible, copayment or coinsurance. These health plans include a set of preventive services, like shots or screening tests, at no cost to you when these services are delivered by a doctor or other provider in your plan’s network.
There are three different categories of free preventive care services. The first category covers services for all adults, the second is specific to women, and lastly, there is a category for children. Click the links below to view detailed lists of the preventive care benefits for each category.
Any services on the above lists should be fully covered by your health plan, regardless of whether you have met your deductible. It is also important to understand that when you go to your doctor for preventive care, they might provide other services that are not covered under your free preventive care benefit or have a cost-sharing fee associated with it.
Some care can be categorized under preventive or diagnostic, depending on the situation. If it is preventive, it will be covered under your health plan, but your insurer can charge you cost-sharing if you have a diagnostic performed. When in doubt, talk with your insurer beforehand so that you’ll understand how your preventive care benefits work before the bill arrives.
Preventive Care and COVID-19
Preventive care as it relates to the coronavirus can be a tricky subject. There is normally a lengthy process involved with adding preventive cares services onto health plans through the ACA, but Congress quickly took action to ensure that most health insurance plans would fully cover the cost of COVID-19 testing under preventive care. The legislation that Congress enacted in the Spring of 2020 before COVID-19 vaccines became available ensured that once the vaccines did become available, health plans would cover the vaccine nearly immediately, without any cost-sharing associated with it.
Many health insurance companies have opted to go beyond the basic requirements, offering to fully cover COVID-19 treatment, as well as testing, for a limited period of time. Those provisions don’t apply to self-insured plans unless the employer opts to waive cost-sharing for treatment, so it’s important to reach out to your health provider to see exactly how your COVID-19 costs are being handled.
Costs of Coverage
Your preventive health care is covered, but that does not mean it is entirely free of charge. Your health plan is required to pay for preventive health care without charging you. However, your insurer takes the cost of preventive care services into account when it sets premium rates each year. Even though you do not pay a deductible or cost-sharing charges when you receive preventive care, the costs of those services are built into the cost of your health plan. This means whether you choose to take advantage of preventive care benefits, you are paying for them through the cost of your health plan premiums regardless.
Elevanta Health is an affordable, ACA-compliant, self-funded group health insurance solution. We offer a variety of plans that are covered by the BlueCross BlueShield network. Click here to learn more about what preventive care services are covered under our plans. If you are an employer looking to get set up with one of our plans, contact us today at health@elevanta.com or 678-540-6203.