Preventive Care Services
As the saying goes, ‘prevention is better than cure,’ and that’s what preventive care is about. Preventive care is routine health care that covers screening, check-ups, and patient counseling. The aim is to prevent illnesses, diseases, and other health problems before they occur.
Preventive Care Services
As the saying goes, ‘prevention is better than cure,’ and that’s what preventive care is about. Preventive care is routine health care that covers screening, check-ups, and patient counseling. The aim is to prevent illnesses, diseases, and other health problems before they occur.
Preventive care service is part of a health insurance plan and the policy pays for the care received to prevent an illness from developing. At Goldstein Healthcare, we have researched the best insurance policies with preventive care service coverage and will help you make an informed choice.
Preventive care service is part of a health insurance plan and the policy pays for the care received to prevent an illness from developing. At Goldstein Healthcare, we have researched the best insurance policies with preventive care service coverage and will help you make an informed choice. Click for more on what is preventative care and what isn’t.
Preventive Care and the Affordable Care Act
The Affordable Care Act (ACA) is a healthcare reform law that became operational in 2010. It was formerly referred to as the Patient Protection and Affordable Care Act. The ACA expanded Medicaid eligibility and prevented insurance companies from denying coverage to policyholders because of pre-existing conditions.
Also, the Affordable Care Act mandates insurers to cover preventive care. Section 2713 of the Act states that private health plans must provide coverage for a range of recommended preventive services and may not impose cost-sharing (such as copayments, deductibles, or co-insurance) on patients receiving these services.
What Is Covered Under Preventive Care Services?
There are three categories of coverage under the Affordable Care Act: adults, women, and children. An ACA-compliant insurance plan must cover these three categories, but the fee schedules may differ based on whether you have a grandfathered or grandmothered plan. Read on to understand your preventative care needs you need.
Preventive Care Services for Adults
If the adult is over 18 years, preventive care will cover the following:
Screenings
Screening coverage includes:
Blood pressure
Abdominal aortic aneurysm (for men of a specified age who have never smoked)
Alcohol misuse
Colorectal cancer
Depression
Cholesterol
Type 2 diabetes
Hepatitis B and C
HIV
Obesity
Lung cancer
Syphilis (for adults who are at higher risk)
Medications
Preventive care services cover aspirin to avert cardiovascular disease for men and women of a certain age.
Counseling
Preventive care services will cover counseling for:
Alcohol misuse
Obesity
Diet counseling for adults at risk of a chronic disease
Smoking cessation interventions for smokers
Sexually transmitted infection (STI) for adults at risk
Immunizations
PCS covers immunization for Hepatitis A and B, human papillomavirus (HPV), and influenza.
Preventive Care Services for Women
Preventive care services for women cover ‘all women’ and ‘pregnant and may become pregnant’ women.
Preventive Care Services for All Women
Breast cancer genetic test counseling for women of higher risk
Cervical cancer screening for sexually active women
Breast cancer chemoprevention counseling
Breast cancer mammography screening every one to two years for women over age 40
Osteoporosis screening for women over age 60, etc.
Pregnant or Women Who May Become Pregnant
Routine anemia screening
Syphilis screening
Breastfeeding supplies for nursing women
Folic acid supplements
Gestational diabetes for women 24-28 weeks pregnant or those at a higher risk of developing the illness, etc.
Preventive Care Services for Children
PCS for children is for those below the age of 18. It covers:
Screenings
This includes:
Behavioral assessments
Blood pressure screening
Autism screening at 18 and 24 months
Depression screening
Obesity screening
Hearing screening for newborns, etc.
Medications
PCS covers:
Gonorrhea-preventive medication for the eyes of all newborns
Iron supplements for children ages 6-12 months at risk for anemia
Fluoride chemoprevention supplements for children without fluoride in their water source
Immunizations
Preventive care services cover:
Hepatitis B
Diphtheria, tetanus, pertussis (whooping cough)
Hepatitis A
Influenza (flu shot)
What Does Preventive Care Not Cover?
Preventive care service does not cover:
Diagnostic tests and screenings
Additional primary care visits
Specialist visits
Alternative therapies
PSA Blood Tests
Is Preventive Care Service Free?
Most health insurance plans provide 100% coverage for the preventive care services listed in the Affordable Care Act. This includes individual health insurance plans and the ones provided by employers. Also, you must use an in-network doctor to enjoy the coverage fully.
Is Preventive Care Service Beneficial?
Yes, preventive care helps you detect illnesses early before they become severe and get proactive treatment. Also, you don’t have to buy an additional health plan as it is part of your health insurance policy.
Preventive Care Services vs. Diagnostic Care
Preventive care services are for the early detection of an illness, while diagnostic care covers the services received after a doctor makes a diagnosis or a discovery. For instance, a radiologist may ask a patient to do a mammogram after a breast screening. Your health insurance plan will cover only the breast screening because it is a preventive service while the mammogram is a diagnostic service.
Goldstein Healthcare is Here for You!
At Goldstein Healthcare, we make it easy for individuals, families, and employers to buy health insurance coverage. Our knowledgeable team will recommend health insurance plans based on your needs.