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Preventative Care and Insurance: What You Need to Know

Preventative Healthcare Insurance is precisely what you would expect from the name: insurance coverage for healthcare screenings and other preventative care measures. Although healthcare insurance policies vary greatly depending on your plan, provider, and location, most healthcare plans offer some form of preventative healthcare coverage.

Since the passing of the Affordable Care Act, all healthcare plans are required to offer some level of preventative healthcare, such as an annual physical exam. In order to maximize your benefits from this coverage, make sure to use an in-network provider and contact your insurance company to find out what other benefits are available to you.

Here we will examine what types of preventative care are normally covered by most American healthcare insurance policies.

What Types of Preventative Care Are Normally Covered by Insurance

Although the services covered depend on your insurance provider and specific policy, some of these benefits are typically included in most plans. The services which are most commonly covered can be broken down into three categories: preventative care for adults, women, and children.

Preventative Care for Adults

This type of care is available to anyone over the age of 18 years and typically includes:

  • Alcohol abuse screenings
  • Blood pressure screenings
  • Cholesterol screenings (may be available for adults of certain ages or those who are at-risk for high blood pressure)
  • Colorectal cancer screenings
  • Counseling, such as counseling for diet/obesity, alcohol/smoking, and sexually transmitted disease prevention
  • Depression and some other mental health conditions evaluations
  • Diabetes screenings (may be available for adults with high blood pressure)
  • Hepatitis B and C screenings (may be available for adults who are considered at-risk)
  • HIV screenings (may be available for adults of a certain age, those who are considered at-risk, or those who may have exposure)
  • Immunizations, typically including hepatitis A, hepatitis B, human papilloma virus (HPV), and influenza (flu shot)
  • Lung cancer screenings (may be available for adults who are at-risk, current or past smokers)
  • Medications, such as aspirin as a preventative for cardiovascular disease
  • Obesity and obesity-related condition screenings
  • Syphilis screenings (may be available for adults who are at-risk)

Preventative Care of Women

These services are commonly available to female patients and typically include the following:

  • Breast cancer screenings, genetic testing, and counseling
  • Cervical cancer screenings (for sexually active women
  • Domestic and interpersonal violence evaluation and counseling
  • Osteoporosis screening (may be available for women of a certain age)
  • Pregnancy screenings and services, including gestational diabetes, hepatitis B screenings during pregnancy, folic acid evaluation and supplementation, and breast feeding support, counseling, and supplies
  • Sexually transmitted disease screenings, including chlamydia, gonorrhea, and HIV
  • Urinary tract infection screenings
  • Well-women annual visit and screenings

Preventative Care for Children

These services are commonly covered for children who are under the age of 18 years and include the following:

  • Autism and developmental screening and other behavior assessments
  • Blood pressure screenings
  • Height, weight, and body-mass index (BMI) screenings
  • Hearing screenings
  • Hypothyroidism screenings for newborns and infants
  • Immunizations, including diphtheria, tetanus, pertussis, hepatitis A, hepatitis B, human papillomavirus (HPV), influenza (flu shot)
  • Medications, including fluoride supplements (for children in areas without fluoridated water), gonorrhea-preventative medications for newborns, and iron supplements
  • Oral health assessments and screenings
  • Screenings for adolescent children, including sexually transmitted diseases, alcohol and substance abuse disorders, and mental health conditions
  • Vision screenings

You May Need a Referral from Your Primary Care Provider

Depending on the type of preventive care, treatment, or screening, you may need a formal referral from your general care provider. Most insurance agencies have policies which depend heavily upon the recommendations of your doctor. If your doctor provides a formal referral or prescription, your insurance is more likely to cover the service. An excellent example of this policy can be seen in insurance coverage of some over-the-counter (OTC) drugs. Even a common OTC drug such as ibuprofen can be covered by insurance if it is prescribed to your by your doctor.

The Takeaway

Preventative care as well as maintenance of ongoing medical conditions is an important part of overall healthcare and general well-being. Which specific services are covered by your insurance will depend to some degree on your insurance policy and the recommendations of your general care provider or the specialist provider you see.

If you believe you need a referral to see a specialist or require a specific screening or other form of preventative care, talk to your general care provider about your concerns and healthcare needs.