« Return to previous page
Understand Preventive Care
Commonly known as your annual checkup or physical, preventive care can help keep you from having health problems or catch a possible problem early. But while it's an important part of your health, a lot of people are confused: What exactly is preventive care? Read on to learn what services are considered preventive and how your health plan covers these services.
Preventive Versus Non-Preventive Services
When you visit a network provider, your plan covers preventive services at 100%. On the other hand, for most non-preventive services, you'll pay a share of the costs. The table below shows the differences between these two types of services.
For your information: The Affordable Care Act defines what's considered preventive care. Learn more on HealthCare.gov
Are you a Medicare member? Learn about preventive and screening services on Medicare.gov
| |
Preventive Services
|
Non-Preventive Services
|
What is it?
|
Preventive services generally:
- Help keep you healthy
- Screen for certain types of cancer
- Immunize you against disease
- Are received annually, or as recommended by your doctor
|
Non-preventive services generally:
- Monitor existing conditions
- Diagnose and treat a new condition
- Address any health concerns you bring up during your visit
|
Examples
|
- Most immunizations
- Well-child visits
- Prenatal care
- Screenings for cancer such as:
- Breast (mammogram or 3-D mammogram)
- Cervical (Pap smear)
- Colon (colonoscopy, CT colonography or other tests)
- Screenings for health concerns such as:
- Blood pressure
- Cholesterol
- Sexually transmitted infections (STIs)
- Type 2 diabetes
- Depression
- Tobacco use
- Alcohol misuse
- Domestic violence
|
- Treatment of illness or injury (e.g. earache, sore throat, cough, broken bone, etc.)
- Earwax removal
- X-rays
- Medication consultation
- Wart removal
- Monitoring ongoing conditions such as:
- Headaches
- Trouble sleeping
- High blood pressure
- Diabetes
- Heart conditions
- Lab tests to monitor existing conditions
|
Common Questions
What if I receive preventive and non-preventive services during one visit?
If you receive both types of care (preventive and non-preventive) at your visit, the preventive services will be covered at 100%. Depending on your plan, you may pay a share of the costs for the non-preventive services.
How do I determine my share of the costs for non-preventive services?
To learn what your share of the costs may be for non-preventive services, call Medica Customer Service at the number on the back of your ID card, or check your policy of coverage by visiting your secure member site.