Preventative Services and Insurance Plans
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.