Health Care Enrollment 2020: Understanding Preventative Benefits

Preventative healthcare or preventive medicine is about being proactive in taking advantage of your preventative benefits that were mandated under the Accountable Care Act (ACA). This allows for disease prevention and instead of disease treatment.

Most health care plans per the Accountable Care Act (ACA) offer preventative screens at no charge, as long as you are seen by a provider in your plan’s network. This includes no copay or coinsurance and is free before you meet your deductible.

Adult Screenings

Preventing screenings include diabetes, cholesterol, and colorectal, as well as mental health screenings for depression and alcohol misuse. 

• Diabetes Type 2 screening recommended for individuals 40 – 70 years of age who are overweight or obese.
  • If not treated, diabetes type 2 may lead to heart disease, kidney failure, and blindness. 

• Cholesterol screenings – recommended every 4-6 years or more frequently based on family history and your physician’s recommendation.
  • If not treated, high cholesterol may lead to a heart attack or stroke.

• Colorectal screenings recommended for individuals 50-75 years or earlier based on family history or your physician’s recommendation.
  • There are several tests, like a home test (Cologuard) or a colonoscopy. Your physician will help you determine the best screening for you and your circumstances.

• Depression screening – if you or a family member are feeling sad or depressed, contact your physician.
  • Depression is a common disease impacting millions of people. If not treated, depression can become severe.

For a full list of preventative screenings: Preventative Care Benefits Adults

Women’s Screenings

Preventative screenings include those for women who are pregnant or are considering pregnancy, such as anemia, folic acid, and preeclampsia prevention and screening. Women’s standard preventative screenings include breast cancer and mammography, cervical cancer, osteoporosis screenings as well as domestic violence, and interpersonal screenings. 

• Anemia screening is recommended as routine for women pregnant or considering pregnancy.
  • The screening detects red and white cell characteristics as well as iron status. A healthy balance is important and can prevent risks to pregnancy.

• Folic acid screenings – recommended for all individuals but is essential for women who are pregnant or considering becoming pregnant. 
  • It may help in the prevention of birth defects.

• Preeclampsia prevention and screening is recommended for women with high blood pressure.
  • Women who may have a family history of preeclampsia or have high blood pressure may be at a higher risk. 

• Breast Cancer screenings are recommended every 1-2 years for women over 40 years of age.
  • Recommended to identify breast cancer or better understand a lump or other change in your breast.

• Cervical cancer screenings recommended for women 21-65 years every 3 years. For Human Papillomavirus (HPV) DNA with a combination of a pap smear every five years for ages 30-65 years of age.
  • These screenings can detect HPV or abnormal cells before they turn into cervical cancer.

• Osteoporosis screenings are recommended for women over 60 years of and risk factors. 
  • There are no signs or symptoms of Osteoporosis, and most don’t uncover they have the disease until they break a bone. A bone density test will help determine how strong your bones are.

• Domestic Violence and Interpersonal screenings are for all women.
  • Understand the warning signs of an abusive or controlling partner. If not addressed, the situation may escalate and put you in an unsafe situation.

For a full list of Women’s preventative screenings: Preventative Care Benefits for Women

Children’s Screenings

Preventative screenings for children range from well-child developmental to mental health, autism, lead poisoning, and obesity, and counseling. 

• Autism screening is recommended for children 18-24 months.
  • Well-child visits are to evaluate your child clinically and developmentally. ACA mandated that wellness visits be covered. Always check with your insurance company and confirm with your particular plan.

• Lead screenings are recommended for children who are believed to have been exposed to lead.
  • Exposure to lead can cause learning, behavioral, and developmental issues If the home was built before 1978, there could still be lead in the home.

• Obesity screening and counseling is recommended if your child is struggling with maintaining a healthy weight for height and age as well as maintaining an active lifestyle.
  • Obesity can lead to self-esteem and health issues. Diet counseling and help is available to promote a healthy lifestyle for your child.

For a full list of Children’s preventative screenings: Preventative Care Benefits for Children

Preventative Healthcare Benefits

The four leading causes of death are caused by preventable chronic diseases: heart disease, cancer, Chronic Obstructive Pulmonary Disease (COPD), and stroke. Detecting early and treating early supports a longer life and lower costs to you. Refer to: Why Preventative Care Lowers Health Care Costs

Review your plan’s Evidence of Coverage (EOC) and understand your preventative benefits. Many insurance companies have a new member onboarding team to go over your benefits in detail.

Due to the cost of health care and plans with a higher deductible, many are concerned about going to see a physician and that costs that may be incurred.  Knowing about preventative benefits that are available to you and your family at no charge is essential for a healthy life, peace of mind, and managing your health care costs.

References:

Preventative Services Tracker

Preventative Care Saves Lives and Money