Preventive Care
Prevention is the best medicine. Our plans include comprehensive preventive care benefits to help you stay healthy and catch potential issues before they become serious problems.
Prevention is the best medicine. Our plans include comprehensive preventive care benefits to help you stay healthy and catch potential issues before they become serious problems.
Preventive care is one of the most valuable aspects of health insurance, yet it's often underutilized. Studies consistently show that routine screenings, vaccinations, and wellness exams can detect diseases in their earliest, most treatable stages, often before symptoms even appear. For conditions like cancer, heart disease, and diabetes, early detection can literally save your life.
Under the Affordable Care Act, all health insurance plans must cover a comprehensive list of preventive services at no cost to you when you use in-network providers. This means no copays, no deductibles, and no coinsurance for these essential services. Despite this, many Americans skip their annual checkups and screenings, missing opportunities to identify and address health concerns early.
Our health insurance plans fully embrace the value of prevention. We cover a wide range of preventive services at 100%, encouraging you to take advantage of screenings, immunizations, and wellness visits that keep you healthy. Investing time in preventive care today can save you from serious health problems and significant medical expenses tomorrow.
Comprehensive yearly checkups to assess your overall health, review medical history, update vital signs, and discuss health goals with your doctor. Includes age-appropriate screenings and personalized prevention recommendations.
Flu shots, COVID-19 vaccines, tetanus boosters, shingles vaccines, pneumonia vaccines, and all other CDC-recommended adult immunizations covered at 100% at in-network pharmacies and doctor's offices.
Cancer screenings (mammograms, colonoscopies, Pap smears, prostate exams), cardiovascular checks (blood pressure, cholesterol), diabetes screening, and other tests that detect diseases early.
Regular pediatric checkups from birth through age 18, including developmental assessments, growth monitoring, vision and hearing tests, and childhood immunization schedules at no cost.
Annual well-woman exams, mammograms starting at age 40, cervical cancer screening, contraceptive counseling, breastfeeding support, and prenatal vitamins as recommended by your provider.
Behavioral counseling for healthy diet, obesity screening and counseling, tobacco cessation programs, alcohol misuse screening, and depression screening covered as preventive services.
Age and gender-appropriate screenings that detect diseases before symptoms appear. Includes blood pressure checks, cholesterol screening, colorectal cancer screening starting at age 45, and breast cancer screening. These tests identify risk factors and enable early intervention.
Vaccines that prevent infectious diseases and their complications. Adults need regular flu shots, COVID boosters, and age-specific vaccines like shingles (50+) and pneumonia (65+). Staying current on immunizations protects you and those around you.
Guidance from healthcare providers on lifestyle factors affecting health. Includes nutrition counseling, weight management programs, tobacco cessation support, and alcohol screening. These services help you make lasting changes for better health.
Certain medications are covered at 100% when prescribed for prevention rather than treatment. Examples include aspirin for cardiovascular prevention in appropriate patients, folic acid for pregnant women, and certain medications to prevent breast cancer in high-risk women.
Different ages require different preventive services. Here's what you should know about screenings and services recommended at various life stages:
Annual wellness exams, blood pressure screening, cholesterol checks (starting at 20 for men, earlier if risk factors exist), diabetes screening if overweight, STI screening, and regular immunizations including annual flu shots. Women should begin cervical cancer screening at age 21.
Continue all previous screenings. Women should begin annual mammograms at 40. Consider diabetes screening every three years. Discuss prostate cancer screening with your doctor if you're male. Eye exams become increasingly important for glaucoma detection.
Begin colorectal cancer screening at 45-50. Consider shingles vaccination at 50. Continue all gender-specific screenings. Lung cancer screening for those with significant smoking history. More frequent cholesterol and diabetes monitoring may be recommended.
Pneumococcal vaccines become especially important. Annual wellness visits focus on fall prevention, cognitive health, and medication management. Continue cancer screenings as recommended by your doctor based on life expectancy and health status.
Yes, when you use in-network providers, preventive services covered under the ACA are at no cost to you, meaning no copay, no deductible, and no coinsurance. However, if a preventive visit reveals a condition that requires treatment or diagnostic testing, those services may be subject to cost-sharing.
A wellness visit (or annual physical) focuses on prevention and health maintenance when you're feeling well. Regular sick visits address specific symptoms or conditions. Wellness visits are covered at 100% as preventive care; sick visits are subject to your plan's normal cost-sharing.
Frequency depends on the specific service and your risk factors. Most adults need annual wellness exams, flu shots yearly, cholesterol checks every 4-6 years (more often with risk factors), and cancer screenings at intervals determined by age and previous results.
It's best to schedule a dedicated wellness visit for preventive care rather than trying to combine it with a sick visit. This ensures the visit is billed correctly as preventive care and covered at 100%. Let the scheduler know you're coming for your annual physical or wellness exam.
Visits to manage existing conditions are generally not considered preventive care and are subject to normal cost-sharing. However, you're still entitled to an annual preventive wellness visit at no cost. Some preventive services related to your condition may also be covered at 100%.
Preventive care saves lives and money. Taking advantage of no-cost preventive services helps you stay healthy, catch problems early, and avoid expensive treatments down the road. Speak with a licensed agent today to find a plan that prioritizes your wellness.