Insurance Blog 19 MAR 21

What Types of Preventive Care Does Health Insurance Cover?

The type of preventative care that health insurance covers depends on whether you have Affordable Care Act (ACA) coverage and the type of plan you are enrolled in. Under the ACA, health insurers must cover certain preventative health care services without requiring you to pay a deductible, coinsurance, or copayment.

If you choose private health insurance, you can still receive benefits that cover preventative care for children and adults. Therefore, when shopping for insurance, make sure you compare preventative care options. Below, we take a closer look at what preventative care is and what types of services are covered by today’s health insurance plans.

What is Preventative Care??

Before choosing a health insurance plan, it is important to have a solid understanding of preventative care. In a nutshell, preventive care detects or prevents serious diseases and medical problems before becoming major. Annual check-ups, immunizations, and flu shots, as well as certain tests and screenings, are a few examples of preventive care. This may also be called routine or preventive maintenance care.

A more comprehensive list of free preventative care services may include


  • Abdominal screenings
  • Alcohol abuse screenings
  • Prescribed aspirin use
  • Blood pressure exam
  • Cholesterol screening
  • Cancer screening
  • Depression screening
  • Diabetes screening
  • Diet counseling
  • Fall prevention
  • Hepatitis screening
  • HIV screening
  • Immunization vaccines
  • STD prevention
  • Tobacco use screening

What is the Difference Between Preventive Care and Diagnostic Care?

Medical terms are not always easy to understand. As a result, there can often be much confusion between preventive care and diagnostic care. 

Diagnostic care is related to services in which your provider is looking for something specific, often based on a preventive test or screening results. For example, a radiologist may ask for a follow-up mammogram for a patient. This follow-up is to check for something that may have been detected during the preventive or routine mammogram. 

The follow-up mammogram is diagnostic and not covered as preventive care. Diagnostic care is designed to detect a current condition and preventing it from becoming worse. Preventive care is designed to prevent a condition from developing in the first place.

Is Preventative Care Free?

It depends on how you look at it. Someone will pay for any type of treatment that a health care provider offers, even if it is the healthcare provider. However, that is rare. So, someone else must pay for it – meaning it will either be you or the insurance company. 

Although your health plan must pay for preventive health services without charging you a deductible, copay, or coinsurance, this does not mean those services are free to you. Your insurer takes the cost of preventive care services into account when it sets premium rates each year.

Although you do not pay cost-sharing charges when you receive preventive care, the cost of those services is wrapped into the cost of your health insurance. This means, whether you choose to get the recommended preventive care, you are paying for it through the cost of your health insurance premiums anyway.

Does Private Health Insurance Cover Preventive Care?

The answer is yes, private health insurance covers preventative care. The Departments of Health and Human Services, Labor, and the Treasury issued new regulations requiring private health plans to cover evidence-based preventive services and eliminate cost-sharing for preventive care.  

New health policies beginning on or after September 23, 2010, must cover preventive services with strong scientific evidence of their health benefits. Plans can no longer charge a patient a copayment, coinsurance, or deductible for these services when delivered by a network provider. However, just like ACA plans, private insurance companies can adjust their premiums accordingly to account for the preventive care costs.

How to Find Out About Preventive Care Benefits

Trying to find an insurance company that offers the type of preventive care you need can be difficult. Therefore, your search for the right plan needs to begin by finding a health insurance broker in your state. A broker can assess your current situation, research and compare companies, and find the right plan applicable to your situation.

Sit down with your insurance broker and discuss any medical conditions you may have to be subjected to based on past illnesses, conditions, family history, or other factors. From there, your broker will help you find the right plan.

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Multiplan is one of the oldest and largest healthcare networks in the U.S. Currently, MultiPlan contracts with over 770,000 respected practitioners, 5,000 hospitals, and 70,000 ancillary care facilities, making it easier than ever you to find a participating healthcare provider in your area. You save an average of 20-30% off inpatient and outpatient hospital charges when you use the MultiPlan Network.

Contact Insurance Enterprise for Premier Health Insurance

If you have questions about group or individual health insurance and need health insurance quotes, contact Insurance Enterprise at 888-350-6605. Speak to a licensed agent and find out more about how you can get an affordable health insurance plan.