Preventive Care: What Qualifies, How to Use It, and Some Tips

In 2013, the CDC estimated that Americans were seeking access to preventive services at only half the recommended rate.

They also noted that chronic disease accounted for most Americans’ deaths (7 out of 10!).

Not to mention, these chronic diseases cost a fortune to manage and treat. The CDC estimated that heart disease, cancer and diabetes accounted for 75% of American health care spending.

Yikes.

An overarching goal of the ACA is to improve public health. Encouraging Americans to eat healthy, exercise, and receive preventive care sounds easy. But fresh produce, gym memberships, and doctor visits are all expensive.

Removing the cost barriers of receiving preventive services increases the likelihood that they will be demanded.

Thus, free preventive care is a benefit of the ACA that has great potential to improve our overall health and wellbeing.

What types of preventive services are covered?

There are over 50 specific services now covered by ACA-compliant plans free of charge. This means that doctors’ offices cannot charge a co-payment or co-insurance  for these services.

There are three categories of preventive health services: services for adults, for children, and for women.

Preventive health services for adults include cancer screenings, blood pressure, cholesterol, and Type-II diabetes screenings. These should be sought by adults to prevent the manifestation of lifestyle diseases. Based on the results of such screenings, doctors may encourage at-risk adults to participate in intervention programs.

Preventive health services for children include immunizations, oral health assessments, vision and hearing screenings, and behavioral assessments. Many of the listed services in this category will be sought by parents at their child’s pediatrician’s office. Pediatric dental and vision services are newly added benefits to ACA-compliant plans.

Preventive health services for women include breast cancer screenings, contraceptives, and well-woman visits. Many of the listed services in this category will be sought by women at their gynecologist’s office. Based on the results of such screenings, doctors may encourage at-risk women to participate in intervention programs. It’s important to note that many of the preventive health services for women are for those who are or may become pregnant.

How do you go about receiving preventive care?

Most preventive care services are carried out by primary care physicians (PCPs). A PCP can be a family doctor (for most adults), gynecologists for women, and pediatricians for kids. A PCP is the doctor you visit most frequently and who has the most detailed version of your medical history.

Most preventive services are recommended by age, frequency, and medical history. For example, women ages 65 or older should seek a bone mineral density screening annually. Such services may be performed at annual wellness visits or during physical exams. Some plans may also recommend dental and vision exams, and you should check with your provider to make sure these are covered, because these are useful to many folks.

Keep in mind that, for these services to qualify as preventive care, they must be delivered by a network provider. Also, make sure your current plan is a non-grandfathered plan to ensure that it follows new ACA preventive care guidelines.

Preventive care tips

• Check with your health plan before you receive the service. If you’re a member of a Florida Blue plan, check out their 2014 Preventive Care Guidelines;
• Make certain that your doctor files a preventive service as such. If any extra services are rendered in addition to the preventive test during the visit, you may be billed for them, but you should not be billed for the preventive test;
• Keep track of the preventive care that you receive to stay on top of your health;
• Exercise regularly and eat well – these are the two best ways to stay healthy, after all!