Health insurance is a vital way to pay for medical care when you need it. It also can help keep you healthy and lower your future costs.
Most health plans must cover a set of preventive services — like shots and screening tests — at no cost to you. This includes those available through the Marketplace(r).
Coverage
Basically, health insurance is a contract between you and an insurer that provides protection against unexpected medical costs. It covers visits to your primary care physician, specialists and other medical providers and services at hospitals.
Preventive care is a set of recommended services that can help prevent disease and keep you healthy. It includes yearly checkups, vaccinations and screening tests for things like heart disease, cancer, and diabetes.
It also involves counseling about smoking cessation and balanced diet habits.
Most health plans must cover a full slate of preventive services at no cost to you, including yearly physicals and screenings for certain conditions, such as high blood pressure and obesity.
The coverage for these services is detailed in your Membership Agreement, Certificate of Coverage or other plan documents. Some of these services are categorized as essential health benefits under the Affordable Care Act (ACA) and cannot have lifetime or annual benefit maximums.
Preventive Care Requirements
The Affordable Care Act requires most private health insurance plans to cover certain preventive services without charging patients a deductible, copayment, or coinsurance. That requirement applies to all non-grandfathered health plans in both the individual/family and employer-sponsored markets.
Preventive care is a broad term for medically necessary treatment that can reduce the risk of illness or disease, promote wellness, and improve the quality of life. It can involve physical examinations, diagnostic procedures, medication, and more.
It can also include social and behavioral support to improve the health of individuals. It can include counseling, referrals, and assistance with accessing care.
The ACA requires that private health insurers cover adult preventive care services recommended by the U.S. Preventive Services Task Force, the Advisory Committee on Immunization Practices (ACIP), and the Health Resources and Services Administration’s Bright Futures Project. The list of adult services includes a number of immunizations, including the flu vaccine and shingles vaccine, cancer screenings, sexually transmitted disease (STD) testing and prevention, vision, cholesterol, and tuberculosis screenings.
Preventive Care Benefits
Preventive care is a way to keep your health in good shape and reduce the risk of illness, disease, or other problems. Unlike traditional medical care, which treats diseases that already produce symptoms or complications, preventive care focuses on identifying health issues before they become a problem and diagnosing them before they can cause severe symptoms.
This can help people live longer, healthier lives, avoid or delay the onset of disease, and lower the cost of treatment by catching diseases early on. However, many Americans lack access to preventive services.
Fortunately, new regulations from the Affordable Care Act (ACA) require most private insurance plans to cover evidence-based preventive services without charging cost-sharing for those services when delivered by network providers. These policies must also apply to specific populations, such as “high-risk” individuals.
Costs
There are several factors that determine the cost of health insurance and preventive care. Some of these include the type of plan, your location, the number of people in your family and your deductible.
When you have a high deductible health plan, you may also have to pay copays or coinsurance for services. These charges can range from 20% to 100% of a medical charge, depending on your health plan.
In contrast, a low deductible health plan often offers less expensive monthly premiums and lower copays or coinsurance. This can make it more affordable for people who don’t have a lot of cash to spare or those who are on limited budgets.
A few other ways to reduce the cost of your healthcare are through health savings accounts (HSAs) or health reimbursement arrangements (HRAs). These options can be paired with a health insurance policy or as a stand-alone solution to help you cover high out-of-pocket costs or uncovered services.
