Preventative Care Overview

Children are the most frequent recipients of preventative care and services. The majority of these services are in the form of immunizations, which work to prevent children from developing illness such as polio, measles and mumps. The rate of immunizations is rising each year and remains one of the few preventative services with little disparities in rates between racial and ethnic groups. Other preventative services for children include the charting of the child's height and weight, which works as an early screening tool for any developmental problems. Due to the increase incidence of Type II diabetes and obesity in young patients, increasingly common preventative services include nutritional services and exercise information. ­

­Women have a number of preventative screening tests to take advantage of. Adult women (and men) should have their cholesterol levels checked yearly and their blood pressure checked every two years. Once sexually active, or once they've reached the age of 21, every woman should get a Pap test, which is a screening tool for cervical cancer. As long as these test results are normal, the test can be repeated once every one to three years. Women over the age of 40 have different preventative needs. At this age, women should begin to get mammograms every year or so, which screen for breast cancer. Women over 50 should also get a test to screen for colorectal cancer. Women over 65 should have regular bone density testing to screen for osteoporosis.

Along with screening tests, there are several medications that can help women prevent illnesses like osteoporosis. Calcium is a common preventative medicine that can prevent a number of bone problems. Pregnant patients often take a plethora of preventative medications, including prenatal vitamins, iron and folic acid -- all in an effort to prevent any complications.

The first and most common preventative tests for adult men are regular checks of their weight, cholesterol levels and blood pressure. For men over 50, a test to screen for colorectal cancer is recommended. Men older than 50 should also consider prostate exams to screen for prostate cancer, with current studies suggesting that they should be done every four years. Of course, along with these tests, preventative care includes counseling on different prevention practices including proper diet and exercise, safe sex practices and even smoke detectors in the home.

So now you know which preventative care you, your child, or your mate needs. But what will your insurance plan cover? The next section can help answer that question.

Insurance coverage for preventative care and services varies widely among health care plans. Catastrophic insurance (or a High Deductible Health Plan) is a type of fee-for-service policy that is designed to give protection against a health catastrophe. In exchange for the plan's low monthly premiums, usually around $25, you receive a higher deductible than most plans, as well as less health care coverage. Therefore, preventative services like routine physicals or cholesterol screenings are not covered.

Managed-care plans do offer some preventative care. Normally, each plan has a predefined schedule of covered screening tests. These schedules are based on a patient's age, sex and any risk factors. In most managed-care plans, these schedules are based on guidelines published by the U.S. Preventive Task Force and the American Academy of Family Physicians.

Preventative care in a preferred provider organization (PPO) can vary depending on this predefined screening schedule. When shopping around for health insurance, ask about preventative care coverage. Common preventative services found in PPO plans are routine physical exams, some adult immunizations, routine gynecological exams and Pap tests for women, mammographic screening for any women over 40, pediatric care and immunizations.

Health maintenance organization (HMO) plans were the first to put an emphasis on preventative care, and they offer these services along with the usual health benefits all for a low monthly fee. Since the beginning, HMOs have encouraged wellness and illness prevention with the belief that these preventative measures are more cost-effective than treating chronic conditions that develop due to lack of screening. In addition, HMO plans require that the patient have a primary care physician (PCP). This allows you to have one regular site of care, and studies have shown that this helps ensure proper preventative care on the proper schedule.

Preventative services that are not covered by most insurance plans are also based on the guidelines published by the U.S. Preventive Task Force and the American Academy of Family Physicians. These noncovered services can also vary by plan, but common examples include bladder cancer screening, routine EKGs for asymptomatic patients, screening asymptomatic patients for Hepatitis B or C, and ovarian cancer screening.

To learn more about preventative care and services, check out the links on the next page.