What to know about preventive care
Preventive care includes routine health services that help catch potential issues early – often before symptoms appear. It’s one of the simplest ways to stay on top of your health, understand your risks and take action sooner when something needs attention.
Common examples of preventive care include:
- Annual physical exams
- Cancer screenings, such as mammograms and colonoscopies
- Mental health screenings
- Vaccinations
- Well-child visits
A simple way to think about preventive care is like regular car maintenance. When you keep up with oil changes, tire rotations and inspections, you help prevent bigger problems down the road. Preventive care works the same way for your health.
Why preventive care matters
Preventive care can make a real difference in both your short-term and long-term health. It helps identify concerns earlier, supports better outcomes and may reduce the need for more complex care later on.
- It can catch issues early. Some conditions can be identified before you notice symptoms.
Example: A mammogram may detect breast cancer before a lump can be felt. - It can improve health outcomes. When issues are found early, treatment is often simpler and more effective.
Example: A screening may show borderline blood pressure or cholesterol levels before they become a larger concern. - It may help lower costs over time. Preventive care can reduce the need for more expensive or invasive treatment later.
Example: A no-cost flu shot may help you avoid a serious illness that could lead to hospitalization. - It supports more personalized care. Preventive care gives you and your doctor useful information to make informed decisions based on your age, history and health needs.
Example: Instead of general wellness advice, you may get guidance tailored to your specific risk factors and goals.
Preventive care vs. non-preventive care
Not all medical care is preventive. Some services are considered diagnostic or are used to manage an existing condition. That type of care is often called non-preventive care.
| Preventive care | Non-preventive care | |
|---|---|---|
| What is it? | Care intended to help prevent future health problems or detect them early, often before symptoms appear | Care used to evaluate symptoms, diagnose a condition or monitor an ongoing health issue |
| What will it cost? | Often covered at no cost when you use an in-network provider | You may need to pay deductible, copay or coinsurance costs |
| Examples | Annual physicals, flu shots and age-based screenings | X-rays for symptoms, follow-up testing or treatment for an existing condition |
Sometimes the same service can be preventive in one situation and non-preventive in another. It often depends on why the service is being ordered.
| Preventive care | Non-preventive care | |
|---|---|---|
| Mammogram | A routine mammogram based on age, family history or recommended screening schedule | A mammogram was ordered because of breast pain, a lump or another symptom |
| Blood glucose testing | A blood glucose test included in an annual physical | Ongoing A1c testing after a diabetes diagnosis |
| Colonoscopy | A routine colonoscopy based on age or family history | A colonoscopy was ordered because of symptoms such as bleeding or irregularity |
You can find more information about the difference between preventive care and diagnostic care here.
When preventive care isn’t free ($0)
Preventive care is often covered at $0, but you may have to pay in certain situations, including:
- Using an out-of-network provider
Preventive services are typically only covered at no cost when you see an in-network provider. - Services were coded as diagnostic due to symptoms
If a test or visit is ordered because of symptoms (instead of routine screening), it may be considered diagnostic and cost-sharing may apply. - Extra services were performed during a preventive visit
If your doctor addresses a new concern or performs additional tests during your visit, those services may not be covered as preventive.
If you’re unsure how a service will be billed, check your plan details or ask your provider before your visit.
Is preventive care covered by my plan?
All Affordable Care Act (ACA) plans cover 10 categories of essential health benefits, including preventive and wellness services. Most health plans cover many preventive services at no cost when you use an in-network provider, including MyPriority® Individual and Family plans.
Coverage can vary depending on the service, your age, your health history and whether the visit is considered preventive or diagnostic. If you’re unsure, it ’s a good idea to check your plan details before your appointment.
You can find a full list of covered preventive services with a MyPriority plan.
How do I know what preventive care I need?
Some preventive services are recommended for nearly everyone, while others depend on your age, sex, family history, health status and risk factors.
For example, recommendations may differ for children, women and men, and some screenings are only advised at certain ages or under certain circumstances.
Your annual physical is a good time to talk with your doctor about what preventive care makes sense for you. They can help you understand which services are recommended and whether a visit or test is likely to be considered preventive or non-preventive.