A Complete Guide to Preventive Care and Insurance Coverage

African male pediatrician holding stethoscope during preventive care visit with boy and mother


Have you been putting off that annual physical or overdue cancer screening because you aren’t sure if it’s covered by your insurance or if you’ll have to pay out of pocket? We get it — navigating the details of insurance coverage can be tricky. But did you know that these and other crucial services are available to you for free? That’s because they fall under the umbrella of preventive care according to the Affordable Care Act.

In this blog post, we’ll help you understand what preventive care is and why it’s valuable to both employees and employers. We’ll also share resources from our carrier partners about what preventive care benefits they offer. So join us as we dive into the world of preventive care and insurance coverage!

What Is Preventive Care?

Preventive care encompasses a range of health services and screenings designed to prevent illness, detect diseases early, and promote overall well-being. Unlike reactive healthcare, which addresses health issues after they arise, preventive care focuses on proactive measures to maintain and improve health.

Examples of preventive care include:

  • Routine check-ups, such as annual physical exams, dental cleanings, and well-child visits.
  • Screenings, such as blood pressure checks, cholesterol screenings, mammograms, Pap smears, and colonoscopies.
  • Immunizations to protect against infectious diseases like influenza, measles, mumps, rubella, hepatitis, and human papillomavirus (HPV).
  • Counseling and education to provide guidance on healthy lifestyle choices, such as diet, exercise, and smoking cessation.

Why Is Preventive Care Important?

Preventive care plays a crucial role in promoting overall well-being and reducing healthcare costs for individuals, insurance companies, and the healthcare industry as a whole. Chronic diseases are a tremendous burden on both patients and the healthcare system. In fact, according to the Centers for Disease Control and Prevention (CDC), 90% of the nation’s $4.1 trillion in annual health care expenditures are for people with chronic and mental health conditions. But by implementing preventive care measures and catching these chronic conditions early, we can save people a lot of pain and money.

For example, colon cancer is the fourth most common cancer in men and women, and it’s the fourth leading cause of cancer-related deaths in the United States (CDC). However, colon cancer is very treatable if it’s caught early on, and studies show that colonoscopies reduce deaths from colorectal cancer by 60 to 70 percent. Fully covering regular colonoscopies as preventive care and catching colon cancer before it develops and requires extensive treatment ultimately saves lives and reduces healthcare costs.

In addition to detecting health issues early and allowing for prompt intervention, preventive care also promotes well-being by encouraging healthy lifestyle choices, such as exercise, nutrition, and quitting smoking. Counseling and education services covered under preventive care offer a holistic approach to improving health, giving patients the knowledge and tools to live longer, happier, healthier lives.

The ACA and Preventive Care Coverage

Enacted in 2010, the Affordable Care Act (ACA) improved access to preventive care for millions of Americans. One of the key provisions of the ACA is the requirement for health insurance plans to cover certain preventive services without cost-sharing, meaning individuals are not required to pay deductibles, copayments, or coinsurance for these services when provided by in-network providers.

Here are some of the preventive care services that must be covered under the ACA:

  • Wellness visits and screenings for conditions such as blood pressure, cholesterol, and diabetes
  • Immunizations recommended by the Advisory Committee on Immunization Practices (ACIP)
  • Tobacco cessation counseling and medication
  • Mammograms for breast cancer screening
  • Pap smears for cervical cancer screening
  • Contraceptive methods and counseling for women
  • Developmental screenings and preventive services for children

You can also visit healthcare.gov to find more information about what specific preventive care services are covered under the ACA. Here are some resources to check out:

Preventive Care Benefits Offered by Our Carrier Partners

We are proud to work with a number of awesome large group, small group, individual, and group dental carriers here in the state of Oregon. Each of our carrier partners offers a full suite of preventive care services to help their members stay healthy and save on healthcare costs.

Here is a list of our carrier partners and links to resources so you can discover what preventive care services are covered by your insurance provider:

Empower Yourself with Preventive Care

In today’s fast-paced world, prioritizing health often takes a back seat to other demands. However, as we’ve explored in this blog post, investing in preventive care is one of the most impactful decisions you can make for your well-being, both now and in the long term. By taking advantage of the preventive care services covered under the Affordable Care Act, you can access vital screenings, vaccinations, and wellness visits without worrying about financial barriers.

At Innovative Benefits Group (IBG), we’re here to help you navigate the complexities of health insurance coverage and ensure you have access to the preventive care services you need. If you have any questions about what preventive care services are covered under your health insurance plan or how to maximize your benefits, don’t hesitate to reach out to us! Your health and well-being are our top priorities.


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