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Last Updated on March 27, 2024 by Insurdinary Editorial Team -->
When considering preventative care, you probably think about routine check-ups with your primary care doctor, but preventative care covers much more than annual appointments. From wellness programs to routine screenings, preventative care aims to prevent and mitigate various issues that could seriously compromise your health. Learning more about these options can help you take control of your health if you've been worried about the costs of doctor's visits.
In March 2010, it became a legal requirement for insurance companies to cover certain preventative services without requiring policyholders to pay a copay, coinsurance, or other forms of cost-sharing, thanks to the Affordable Care Act (ACA). By making these services more affordable and accessible for patients, they also help promote wellness and preventive care.
Under the ACA, insurance companies must cover the costs of certain preventative services for adults and children. When receiving one of these services, you are not responsible for sharing the cost with your insurance company; instead, you receive full coverage for the service.
So, which services does this include? In short, insurance companies must cover any preventative services the ACA deems essential for maintaining well-being. These services range from vaccines to screenings. Let's look at them in more detail below.
One of the essential preventive care services that health insurance policies must cover is routine immunizations for the following:
The Advisory Committee on Immunization Practices deemed the immunizations above necessary and routine. Additionally, insurance companies can only require a 15-day waiting period before you can receive full coverage for these immunizations.
The U.S. Preventive Services Task Force has a list of recommendations for evidence-based services to which it assigns “A” and “B” ratings. Insurance companies must cover these services without requiring copays or other forms of cost-sharing from you. The letter ratings show that the USPSTF believes the services are significant health preservation strategies.
These services include screenings for the following conditions:
In addition to the screenings above, evidence-based services include counseling for common health issues like drug use.
Women can receive the following preventative services without sharing the costs with their insurance company:
The ACA requires insurers to cover multiple types of services that can help improve and promote the well-being of children of all ages. These services include routine well visits, fluoride supplements, immunizations, and the following types of screenings:
Although the ACA requires health insurance plans to cover preventative services without cost-sharing, some exceptions exist. For instance, you may be responsible for a copay if you visit your doctor for a non-routine appointment. You may also need to share costs if you visit an out-of-network healthcare provider when the service you need is available from an in-network provider.
You could also be responsible for paying for some of the cost of a treatment that follows a recommended service. This could include cancer treatments after a screening revealed cancer in your body. While the insurance company will have to cover the screening itself, it does not have to provide full coverage for any treatment that follows.
Doctors can successfully treat a wide range of diseases with early detection. Even serious diseases like cancer have better chances of successful treatment if you catch them in their initial stages. That’s why preventative services are so crucial.
Thanks to the ACA, essential preventative care is more affordable and accessible, which can encourage more people to take advantage of these services and improve their overall health.
Disease prevention measures like vaccines can help protect patients from life-altering diseases. This helps people protect themselves while saving money in the long run by avoiding the costs of expensive treatments, procedures, and hospital stays.
You can enjoy a greater quality of life by taking better control of your health. Health insurance does this by covering the costs of essential services like screenings and immunizations. Preventative care can also inform you about certain risks and how to manage chronic conditions like diabetes and obesity.
Preventative care can’t prevent everything, but early detection and treatment can go a long way in managing symptoms and addressing the disease or condition. For instance, certain types of cancer are significantly more treatable with early detection, making routine screenings essential.
Health insurance does more than make preventative care more affordable for patients. It also helps foster relationships between patients and their healthcare providers and encourages patients to make healthier decisions, but this is just the tip of the iceberg.
Before the ACA, health insurance companies could require you to pay copays for routine healthcare services. While these weren’t necessarily expensive, they made some patients hesitant to pursue proactive health maintenance.
Moreover, patients usually didn’t visit their primary care providers until something was wrong, which meant several ended up paying for expensive treatments and procedures due to delayed detection. Now, health insurance makes preventive healthcare services more affordable, so you can receive the care you need without straining your finances.
No two patients are the same, which means everyone has different risk factors and medical needs. Health insurance companies have been taking a less universal approach by assessing the different risks and medical backgrounds of policyholders. This assessment allows the insurer to encourage the patient to take advantage of certain wellness programs and preventative services that can help improve overall well-being.
Health insurance companies want policyholders to be as healthy as possible, thus incentivizing patients to embrace healthier habits like regular exercise. Health insurance companies can also offer coverage for programs that help people quit smoking or even offer cash prizes for policyholders who achieve different healthcare challenges.
Healthcare professionals, regardless of specialty, need access to the right information to deliver the best care for their patients. Health insurance companies collect a wide range of data for policyholders, including different risk factors and medical conditions. By working with healthcare professionals, insurance companies can use this data to identify common health concerns and develop wellness programs to address them.
Doctors and other healthcare providers must have solid relationships with their patients to provide the best care possible. By encouraging patients to take more action toward preventative care, health insurance companies help foster long-term relationships between patients and physicians. As a result, patients can feel more comfortable asking questions and discussing different health-related concerns with their physicians.
Many companies offer basic health insurance benefits to their employees. Employees take fewer sick days when taking advantage of these plans and the preventative care services they offer.
For example, suppose you use your company’s healthcare plan to get routine annual check-ups with your doctor. In that case, you have a better chance of identifying and getting ahead of diseases or conditions that could impact your well-being.
Several studies have shown that preventative services have an important relationship with workplace absenteeism. For instance, one study published in the journal Health Affairs found a 25% reduction in absenteeism for employees who partake in wellness programs compared to those who don’t.
Thanks to the Affordable Care Act, patients can access more affordable preventative care services essential for their well-being. However, the lack of cost-sharing requirements for these services is just one part of the role that health insurance plays. Insurers also help promote better physician-patient relationships, encourage people to participate in various wellness programs, and help patients get the early detection and treatment they need for a wide range of conditions and treatments.
Preventative healthcare services can go a long way in protecting your health and well-being. While immunizations help prevent a wide range of diseases, routine screenings can detect serious conditions early and let your doctor provide the necessary treatment as soon as possible. If you’re ready to take control of your health and start exploring health insurance plans, our team at Insurdinary can help. We simplify the process by helping you compare quotes from multiple providers and find the right plan for your budget and wellness needs. Contact us today to explore health plans that can help you embrace the many benefits preventative care brings.