What is Preventive Care?

Preventive care means medical services that focus on preventing disease and evaluating a person’s current state of health. Examples include annual well visits, most immunizations, and screening tests such as mammograms. The Affordable Care Act (ACA) requires private insurance plans to cover certain recommended preventive services without imposing cost-sharing (e.g., copayments and coinsurance) on patients receiving them.


Preventive care includes certain services that may be based on  exams, tests or procedures that are recommended by public health experts based on certain factors including, but not limited to, age, risk factors, family history and other conditions you might already have. These preventive services are designed to keep you healthy and screen for unidentified illness that may not have caused any symptoms yet.


Choosing a Provider that Can Help You with Preventive Services

We encourage members to receive an annual or routine preventive visit with a primary care physician (also known as a PCP) which qualifies as no-cost-share preventive care. PCPs could be a family practitioner, a physician or nurse practitioner specializing in general or internal medicine, a pediatrician or an ob/gyn. A relationship with a PCP is highly valuable because your PCP can help you navigate the health care system and coordinate care if you ever need it.


Payment for Preventive Services

When it comes to out-of-pocket expenses for certain preventive services, there is a distinction between “no-cost-share preventive care” under the ACA and other services that may be considered preventive by you or your health care provider. .


Not all laboratory tests or studies are covered at 0$ cost share during a routine, preventive exam.  For example, if you present to a provider for a routine, health maintenance or preventive exam, it is implied that the visit is not problem oriented.  That is to say, a preventive exam, by definition, is designed to detect illness in generally well patients without current concerns or symptoms of illness.


Back to blog.