Health Insurance and Preventive Care: What’s Covered?

With plans, networks, providers, and deductibles, navigating health insurance coverage can be challenging. It’s important to know that, regardless of the type of plan, preventive care is covered. However, what is considered preventive care can vary depending on a person’s age, sex, or health conditions.

What Is Preventive Care?

Preventive care is the care people receive to prevent illnesses or diseases. This can include immunizations and certain counseling, depending on pre-existing conditions. For example, a person dealing with obesity can be covered for obesity screening and counseling. The idea is that spending less now to prevent illnesses and higher costs at a future date is an efficient way to keep healthcare costs down for consumers. Preventive care also helps people live longer and healthier lives.

What Are Some Common Types of Covered Preventive Care Services?

Standard immunizations and annual wellness visits are considered preventive care under nearly all health insurance plans. Pediatric screenings for hearing, vision, autism and developmental disorders, depression, and obesity are considered preventive services for children. Screenings for depression, cholesterol, blood pressure, and tobacco use are covered for all adults. Other services depend upon age, health risk, or sex. For example, lung cancer screenings are only considered preventive for adults aged 55 to 80 that are heavy smokers or who have quit in the past 15 years. Tuberculosis, hepatitis B, and hepatitis C screenings are only considered preventive for patients considered high-risk. For women who are pregnant or who may become pregnant, some components of women’s health are covered, including anemia screening, contraception, and folic acid supplements.

Would a Patient Ever Have to Pay for Preventive Care?

It is unlikely that a patient would ever pay for preventive care services, but there are scenarios where this can happen. If a person seeks care from a provider outside of their network, those services may not be covered. Also, if during a screening something is uncovered that requires treatment, the treatment would not be considered preventive care. If patients are ever unsure about what services are covered and what is considered in-network, it is best to contact the insurance provider.

If you need health insurance or any other type of insurance in Oregon, you can rely on the independent agents at Focus1 Insurance Group to help you find a great plan. Read our testimonials and learn more about our services. Request a free quote today.