Every year as we come around to the annual open enrollment period, the topic of preventive care comes up. Many may think that preventive care is the same as medical care, but they are different.


Medical Care vs. Preventive Care

When you choose health care coverage, you think about how you use health care. Some people have chronic diseases that they must manage with a doctor’s help all year long. Others may get injured or catch infections. This type of treatment of disease and injury is considered medical care.

So what is preventive care?

Just as proper diet, exercise and healthy lifestyle can all help avoid certain health problems, preventive care is important and worth your time. Even if you don’t feel like you are having any health problems, you should have a yearly exam by your doctor. Preventive screenings can help catch problems early, sometimes before symptoms are noticeable.

Your doctor will give you a physical exam, do screenings for things like blood pressure and cholesterol levels, and talk with you about your health concerns. Your doctor can also make sure you are getting the shots you need to prevent illness. 

Why Fix What Isn’t Broken?

Preventive care may help you avoid some health problems, or find health problems early, when your chances for treatment and cure are better. 

  • Catching disease early rather than later generally leads to better health outcomes and lower costs.
  • Experts estimate that 7 in 10 American deaths each year result from preventable chronic diseases like diabetes and heart disease. We spend 95 cents of every medical care dollar treating chronic diseases.
  • The National Prevention Strategy of the Surgeon General of the United States points out that 1 of every 5 U.S. health care dollars is spent on caring for people with diagnosed diabetes. Type 2 diabetes can be prevented in many cases. Preventive care screenings can catch the very early signs that this type of condition is developing.

All of our qualified* health insurance plans cover certain preventive health care services with no out-of-pocket costs.* That means you are not charged a copayment or coinsurance even if you haven’t met your deductible.

You can find complete details of the preventive services your plan covers in your benefit book. It’s important to note that you will be able to get these services with no out-of-pocket costs only when you go to a doctor or clinic in your plan’s network.

To make sure a doctor or clinic is in your plan’s network, use our Provider Finder® tool. Log in to Blue Access for MembersSM and click on the Find a Doctor or Hospital tab to access the tool.

When Preventive Care and Medical Care Can Cross Paths

There are both “screening” and “diagnostic” versions of many tests, such as mammograms and colonoscopies. A screening version is considered preventive care. A diagnostic test is considered medical care.

The technology for these different versions may be similar, but the tests may be done from different angles, for different times and by different clinicians based on the situation.

To avoid unnecessary or unplanned out-of-pocket costs, it is always a good idea to make sure you’re getting the type of test that you need. There’s no need to pay for diagnostic testing if all you need is a screening test.