Reviews of Blue Shield Coverage of Preventative Care
Many people may not know that there are two types of care you can receive when you go to the doctor — preventive care and medical care. The type of care is different, and your costs may be different, too.
Medical Care vs. Preventive Care
Think about how people use health care based on their needs. A person with a chronic disease may need to see a doctor or specialist often. Others may have occasional injuries or infections. Treatment of disease and injury is considered medical care.
So What Is Preventive Care?
Proper diet, exercise and healthy lifestyle can all help avoid certain health problems. Preventive care does the same thing. Preventive screenings can help catch problems early, sometimes before you notice symptoms.
Yearly preventive exams and screenings may include:
- A physical exam
- Screenings for things like blood pressure and cholesterol levels
- Talking with your doctor about any health concerns
- Vaccines you need to prevent illness
- Mammogram screening
- Colon cancer screening
- Cervical cancer screening
Sometimes Preventive Care and Medical Care Cross Paths
There are both "screening" and "diagnostic" versions of many tests, such as mammograms and colonoscopies. A screening version is considered preventive care. Preventive screenings are usually ordered at certain ages and at regular intervals when there is no reason to suspect a problem.
If a person has symptoms or anything looks unusual on a screening test, they may need a diagnostic test, which is considered medical care. Diagnostic tests take a closer look to see if disease is present.
The technology for diagnostic and medical tests may be similar. But where and when you take them and who reads the results are different. The out-of-pocket costs are also different.
To avoid unnecessary or unplanned out-of-pocket costs, find out which kind of test you are getting before you make your appointment and again before the test starts. There's no need to pay for diagnostic testing if all you need is a screening test. But if you do need a diagnostic test, find out in advance what your out-of-pocket costs will be.
Why Fix What Isn't Broken?
Even if you feel healthy, once a year you should get a preventive checkup from your doctor. Preventive care may help you avoid some health problems, or find health problems early, when your chances for treatment and cure are better.
A preventive checkup is worth your time and effort because:
- It can catch disease early and may lead to better health outcomes and lower costs.
- Seven in 10 American deaths each year are from chronic diseases like diabetes and heart disease. These conditions are preventable or treatable in many cases.
- One of every 5 U.S. health care dollars is spent on caring for people with diagnosed diabetes. Preventive care screenings can catch the very early signs that this type of condition is developing when lifestyle and dietary changes may help lower risk or even reverse the condition.
Our qualified* health plans cover most preventive health care services with no out-of-pocket costs when you go to your primary care provider or medical group (for HMOs) or a doctor or medical center in your plan's network (non-HMO plans).* You pay no copay 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. 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 Provider Finder.
*If you have a grandfathered plan (a plan that was in existence on or before March 23, 2010), preventive care without out-of-pocket costs may not apply to you.
Sources: Chronic Disease Prevention and Health Promotion, 
Centers for Disease Control and Prevention (CDC), 2021; Health and Economic Costs of Chronic Diseases, CDC, 2021
Originally published 12/30/2019, Revised 2020, 2021
Source: https://connect.bcbsil.com/my-coverage-explained/b/weblog/posts/preventive-or-medical
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