What Exactly Is Preventive Healthcare? 9 Doctors Weigh In
You’ve heard your health insurance should cover preventive healthcare, but what exactly does that mean? After all, “preventive healthcare” seems like it could cover a wide range of doctor’s visits and health tests. To get it right, we asked nine medical experts to explain preventive healthcare and whether health insurance actually covers it.
“Preventive healthcare is defined as a series of diagnostics, treatments, therapies and lifestyle adjustments aimed at preventing disease and maintaining an optimized level of health and well-being,” says Dr. Sajad Zalzala, co-founder and chief medical officer at AgelessRx in Detroit, MI.
What is preventive healthcare?
Preventive healthcare is a type of care you receive before you develop symptoms. “Rather than waiting for symptoms to appear, it focuses on routine screenings, immunizations, physical exams and lifestyle counseling to maintain wellness and catch problems early,” says Dr. Pamela Tambini, physician and medical director at Engage Wellness in Acton, MA. “The goal is to help people live longer, healthier lives by reducing the risk of chronic diseases and complications.”
“When we look at preventive care, we are looking at every facet of your life from lifestyle habits to diet and exercise to see how we can support longevity efforts by optimizing your healthspan [time spent free of disability and chronic disease] and extending your lifespan,” says Zalzala.
Most health insurance plans cover preventive health services for free, according to HealthCare.gov, as long as the doctor or provider performing the care is in your plan’s network. Your plan may also cover nutrition counseling with a registered dietician nutritionist (RDN), who can recommend dietary changes to prevent or improve health conditions like diabetes, high blood pressure or metabolic disorders.
For nutrition counseling, you might have to pay a copay or toward your deductible. Check your policy coverage details to determine what preventive healthcare services your plan covers.
What is considered preventive care for adults?
Preventive care for adults can differ depending on age, gender and life stage. “Generally, for adults, preventive healthcare includes an annual checkup with a board-certified doctor, regular screenings, immunizations and elevating lifestyle habits that promote healthy blood pressure, cholesterol and A1C levels,” says Dr. Innocent Clement, CEO and founder of digital preventive healthcare platform Ciba Health.
Besides checking vitals, such as blood pressure, height, weight and pulse, HealthCare.gov states that preventive care for adults can include the following:
“Common preventive care screenings for seniors include tests for diabetes, colorectal cancer, breast cancer, osteoporosis, cholesterol and dementia, among others,” says Dr. Anitha Mullangi, chief medical officer for CenterWell Senior Primary Care in Tennessee.
Preventive care for women and pregnant people
Women and pregnant people will likely need additional screenings to ensure they’re healthy. Preventive care for women and pregnant people may include:
- Bone density screening for women who have gone through menopause or are over 65
- Breast cancer genetic testing counseling (BRCA) and mammograms
- Birth control
- Gestational diabetes and preeclampsia prevention and screening
- Tobacco counseling and intervention for pregnant smokers
- Breastfeeding counseling and support
- Maternal depression screening
- Sexually transmitted infection counseling and screening
- Well-woman visits
- Pap smears (cervical cancer screening)
- Colonoscopies
Preventive care for men
“Men are often guilty of skipping checkups, but preventive care is essential,” says Dr. Haleem Mohammed, chief medical officer at Gameday Men’s Health. He says preventive care for men typically includes:
- Metabolic and testosterone screenings
- Prostate health discussions
- Annual physical exams
- Mental health screens
- Vaccinations
- Colonoscopy starting at age 45 (or earlier if there’s a family history)
What is preventive care for children?
“Preventative care [for children] includes counseling, such as making healthy lifestyle choices, as well as vaccinations to prevent childhood diseases and screenings to ensure growth and development are proceeding within a normal range and vision and hearing are healthy,” says Dr. Michael Glazier, pediatrician and chief medical officer at Bluebird Kids Health in West Palm Beach, FL.
Both Marketplace and Medicaid plans, along with most other health plans, cover most preventive healthcare for children at no cost. Services can include:
- Bilirubin concentration, blood, hearing and hypothyroidism screenings for newborns
- Autism screening between 18 and 24 months
- Development screening under age 3
- Well-baby and child visits
- Height, weight and body mass index (BMI) measurements
- Behavioral assessments
- Depression screening routinely starting at age 12
- Immunizations
- Hepatitis B and HIV screening for high-risk adolescents
- Hemoglobin, hearing and vision screenings
What is not considered preventive care?
Preventive care is similar to vehicle maintenance. You take your car in regularly to get the oil checked, rotate your tires and inspect your brakes to ensure everything is running smoothly and to catch any issues before they become problems that might leave you stranded on the side of the road. But it’s no longer preventative if you’re limping into the mechanic with an oil leak or squeaky brakes.
“Any medical services that involve treating an existing illness or condition are not considered preventive care,” says Dr. Partha Nandi, gastroenterologist and chief medical officer of Pinnacle GI Partners.
Going to a doctor, urgent care or emergency room because you have flu symptoms, chest pain or feel fatigued or nauseous is also not preventive care. “Also, alternative therapies like chiropractic, massage and acupuncture are not preventive care,” says Mullangi.
“Simply put, any care that is reactive — whether to a diagnosis, disease or injury is not considered preventative care,” says Clement.
Preventive test vs diagnostic test
“Preventive testing is for people without symptoms. Diagnostic testing is for people with symptoms,” says Dr. Matthew A. Weissman, chair of medicine at Maimonides Medical Center in Brooklyn, NY. The same test can be preventive or diagnostic, depending on why you’re getting it.
For example, getting a mammogram as a baseline test because you just turned 40 but otherwise have no risk factors or symptoms would be considered preventive testing. But if you’re doing a self-exam at home and find a lump in your breast, a mammogram would be considered diagnostic testing to rule out breast cancer.
At 45, your doctor may recommend a preventive colorectal cancer screening at your annual checkup. But suppose you schedule an appointment because you have symptoms like bowel changes or abdominal pain. In that case, your doctor may send you for a colonoscopy diagnostic test to determine the cause of your symptoms and rule out colon cancer.
The importance of knowing your family history
Knowing your family history can help your doctor tailor preventive testing to your specific needs. “The family history helps us understand risk so that we as physicians and care providers can make better and more pertinent preventive care recommendations,” says Dr. Frank Dumont, senior medical director at Virta Health.
If one or more close relatives, such as your parents or siblings, have a chronic condition like heart disease or cancer, it raises your risk of developing the same condition and may warrant earlier screenings than recommended.
For example, the American Academy of Ophthalmology (AAO) recommends adults with no family history or signs of eye disease receive a baseline screening to test for ocular diseases at 40. But, since my dad has glaucoma, my eye doctor recommended I see an ophthalmologist at 35 for a baseline screening. Luckily, I don’t have any signs, so the ophthalmologist told me to come back at 40 and then annually after that. The recommendation is usually every two to four years between the ages of 40 and 54 if you don’t have any signs or risk factors like me.
The bottom line
Being proactive with preventive healthcare can help you live a longer, happier and healthier life. Getting routine screenings, testing and checkups done can identify conditions before symptoms arise, especially if you have a family history of a specific health condition or disease. Most preventive services are free through your health insurance plan. Early treatment can also save you money on future healthcare costs.