What Is Preventive Care and What Does Insurance Cover?

Preventive care is one of the most valuable benefits included in your health insurance plan, and under the Affordable Care Act (ACA), most preventive services must be covered at no cost to you when you use an in-network provider. This means no copay, no coinsurance, and no deductible for qualifying services. Yet studies show that many Americans don't take full advantage of these free benefits, missing opportunities to catch health issues early and avoid costly treatments down the road.

What Counts as Preventive Care?

Preventive care includes services designed to prevent illness or detect health conditions before symptoms appear. The U.S. Preventive Services Task Force, the Advisory Committee on Immunization Practices, and the Health Resources and Services Administration determine which services qualify. Key categories include:

• Annual wellness visits. A yearly check-up with your primary care provider to review your overall health, update your medical history, and discuss any concerns.
• Immunizations. Vaccines for flu, COVID-19, hepatitis, HPV, shingles, tetanus, and others are covered for appropriate age groups at no cost.
• Cancer screenings. Mammograms, colonoscopies, cervical cancer screenings (Pap smears), lung cancer screenings for eligible patients, and skin cancer checks are all covered.
• Cardiovascular screenings. Blood pressure checks, cholesterol screenings, and other heart health assessments are included in preventive care benefits.
• Diabetes screenings. Blood glucose testing for adults with high blood pressure or other risk factors is covered.
• Depression and behavioral health screenings. Mental health screenings for adults and adolescents are included as preventive services.
• Pediatric preventive services. Children's well-child visits, developmental screenings, vision screenings, hearing tests, and childhood immunizations are all covered.

Important Things to Know

While preventive care is free, there are important distinctions to understand. A service is only considered preventive when it's performed for screening purposes on an asymptomatic patient. If you go in for a wellness visit and your doctor discovers a problem that requires additional testing or treatment during the same visit, those additional services may be billed separately and subject to your deductible and cost-sharing. Additionally, preventive care must be received from an in-network provider to be covered at no cost. Out-of-network preventive services may not be free.

It's also worth noting that the list of covered preventive services is updated periodically. New screenings and vaccines are added as medical evidence evolves, so check with your plan or the healthcare.gov website for the most current list of covered services.

Taking advantage of your preventive care benefits is one of the smartest things you can do for your health and your wallet. If you're unsure which preventive services you're eligible for, or if you need help finding a plan with strong preventive care coverage, contact Resilience Health Advisors. We'll help you understand your benefits and create a plan to use them effectively throughout the year.