It’s all well and good to get to the doctor or hospital when there’s a problem that needs to be addressed. But, in recent years, more and more emphasis is being placed on ways to avoid that situation in the first place.

Why? Because it can save you time and money. Plus, it can help reduce the overall burden of medical and healthcare costs in our economy.

The overall term for this approach is preventive care. And it’s become even more prominent with the Affordable Care Act which currently requires health plans to include essential benefits in 10 areas:

  • Preventive, wellness and disease management
  • Emergency care
  • Ambulatory care
  • Hospitalization
  • Maternity and newborn
  • Pediatrics, including dental and vision
  • Prescription drugs
  • Laboratory services
  • Mental health and substance abuse, including behavioral
  • Rehabilitation and habilitation

Understanding Preventive Care vs. Follow-Ups

The law also requires 100% coverage of preventive care, as a reflection of its importance in improving overall health and wellness as well as reducing costs. What does preventive health care mean? The idea is to stay a step ahead of potential illnesses and other medical conditions by taking a proactive approach to your health.

What does preventive care include? Here are a few examples:

  • Wellness visits and standard immunizations
  • Screenings for blood pressure, cancer, cholesterol, depression, obesity and Type 2 diabetes
  • Pediatric screenings for hearing, vision, autism and developmental disorders, depression, and obesity

Be aware that you may be required to pay at least a share of follow-on services recommended after these kinds of preventive services. It’s a good idea to make sure you have the information you need from your doctor concerning additional potential costs.

Things that may not be covered at 100% include additional tests, follow-up visits and referrals to specialists. There may also be limitations on how many preventive services, like wellness exams, are covered within a certain timeframe. Seeing your doctor to diagnose, monitor or treat a specific illness is not considered preventive.

So make sure you – and your doctor – understand clearly the types of preventive care that your insurance policy covers.

It’s a Family Affair

Preventive care and a priority on wellness applies to everyone: children, women and men.

It’s probably no surprise that kids receive such care most often, with the majority in the form of immunizations for conditions like mumps, measles and polio. Other services for children include tracking their height and weight, which can help with early identification of development issues. And, unfortunately, Type 2 diabetes is on the rise in children.

For women, screenings for cervical cancer, breast cancer, osteoporosis and colon health are important at the appropriate ages. Women can also benefit from taking calcium for bone health as well as supplements for iron and needed vitamins. And, of course, pregnant women should often take prenatal vitamins.

Recommended preventive screens for men typically include a first colon screening after the age of 50, per their doctor’s advice. The frequency of later screenings is often based on the results of each one. Similar guidelines apply to screenings for prostate cancer.

Men and women should both monitor their weight, cholesterol and blood pressure on a regular basis. And everyone can benefit from a good diet, regular exercise and not smoking.

Check Your Bills

If you find yourself in a situation where you’ve been charged for services that you think should be considered preventive, you can ask your doctor’s office how those services were billed to your insurance company and, vice versa, check with the insurance provider. You may be able to receive reimbursement if there was a mistake in your billing.