The healthcare industry offers many facets of service, each addressing different aspects of physical health. Preventive care, for example, differs from diagnostic and rehabilitative care in many respects. But what is considered preventive care, and what are the advantages of seeking this type of healthcare?
Preventive Care Defined
Preventive care simply refers to health services meant to prevent the contracting and progression of diseases or adverse medical conditions. These services are designed to catch health issues before they develop into more serious afflictions and become more challenging for physicians to treat.
Primary prevention addresses issues before they happen. Generally, it covers lifestyle changes, health education, and standard steps to avoid illnesses. Vaccinations, mammograms, general blood work, and colonoscopies are all examples of primary prevention.
Note that if you’ve had a previous diagnosis for any of these mentioned above, such as a previous cancer diagnosis, polyps, etc., future screenings may be considered diagnostic and not preventive.
What Health Services Are Not Considered Preventive Care?
Though specific aspects of preventive care may overlap with other forms of healthcare, these types of services are not considered preventive care:
Emergency Care: Urgent medical attention and intervention
Acute or Curative Care: Practices that address existing conditions or illnesses
Palliative Care: Relief from symptoms focusing on quality of life
Diagnostic Services: Tests and procedures like lab tests, biopsies, and imaging
Surgery: Either complicated or routine procedures
Focused Healthcare Services: Maternity, mental health, dental and vision care, and other directed procedures
While preventive care can resemble other forms of care in practice, it is specifically oriented toward preventing conditions before they start or develop further.
Differences Between Preventive Care and Diagnostic Care
Preventive care and diagnostic care may sound synonymous — isn’t diagnosing a problem in the same ballpark as preventing it from happening? However, in medical terminology, there are marked differences between the two.
Preventive care has these unique traits:
Purpose: To screen for or prevent a disease
Timing: Care occurs before the disease begins or spreads
Focus: Addresses overall health, quality of life, and well-being
In contrast, diagnostic care has these qualities:
Purpose: To identify diseases or conditions that already exist
Timing: Care occurs after symptoms have developed or conditions are identified
Focus: Addresses a specific issue or condition
While many duties and activities are similar between the two types of care, the intent and object of preventive and diagnostic care are not the same.
Preventive Care and Insurance
How medical insurance covers preventive care varies from carrier to carrier and region to region. In the U.S., some regulations require insurance companies to provide preventive services at no cost. The Affordable Care Act (ACA) exempts many patients from copayments and deductibles for certain services, such as cancer screening or counseling.
When in doubt, reach out to your health insurance carrier for confirmation of coverage or provider network status.
Can You Be Charged for Preventive Care?
Please note that preventive care can only be covered at 100% if your provider is considered in-network with your plan.
There are some situations in which a patient might be responsible for paying for preventive care. One of the most common is using an out-of-network provider. Most insurance plans come with a list of preferred providers and may charge for preventive care from a physician who is not on such a list.
Some insurers limit or deny coverage for specific procedures. Travel vaccinations or experimental procedures are common exclusions among some insurers. They may also restrict coverage for people who face certain risk factors or who fall outside a certain age range.
In particular, “grandfathered” healthcare plans — already in place when the ACA and other federal regulations passed — may have certain exclusions, rules, or limits. Such plans require some form of co-payment when the plan holder is seeking preventive care.
Why Is Preventive Care Important?
Preventive care is vital to maintaining a strong health profile. The sooner a person can anticipate health issues, the likelier it will be that treatment will be successful. By addressing disease progression before it starts, physicians and their patients have more treatment options.
Additionally, preventive care is almost always cost-effective. It can reduce or eliminate the need for extended hospital stays, invasive surgeries, and prolonged treatments or programs. That’s why routine screenings with your primary care provider are so important.
While life can get busy and scheduling time to see a doctor may not always be simple, there are now a variety of ways that you can get preventive care, even virtually.
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