Preventive care is any medical service that protects against or reduces the likelihood of health emergencies. It is covered under the Affordable Care Act (ACA) and helps keeps health care costs low.
Learn more about what counts as preventive care and how this affects your health care and insurance costs.
- Preventive care can catch and prevent health problems before they become acute.
- Preventive care can also reduce emergency room visits, which are costly to hospitals and insurers.
- The Affordable Care Act requires preventive care to be fully covered.
- By making preventive care free, the ACA makes it easier for people to get treatment before they require emergency care.
What Is Preventive Care?
Preventive care, or preventative care, is health care that prevents disease, injury, or illness, rather than treating a condition that has already become catastrophic or acute. The goal of preventive care is to help people stay healthy.
Preventive care can include:
- Doctor visits, such as annual physicals, well-child visits, annual gynecological care, and dental cleanings
- Allergy medications
- Colonoscopies and mammograms
- Screenings, such as tests for skin cancer, high blood pressure, and high cholesterol
Preventive care also keeps people productive and active, enabling them to keep earning well into their senior years. Health problems forced 35% of retired people into early retirement before they were financially ready. Access to affordable preventative care can help lower these numbers.
Why Does Preventive Care Matter?
Preventive care helps lower health care costs in America by preventing or treating diseases before they require emergency care. Hospital care is very expensive, making up about a third of all health care costs in America.
The cost of emergency room care for the uninsured can be extremely high. Hospitals are required to provide care, even if the patient cannot afford to pay for the services they need. Because the hospital must recover these costs from somewhere, they get shifted to health insurance premiums and to Medicaid. This increases the costs of health care for everyone.
In 2018, 21.3% of adults had one or more emergency room visits. Adults who do not have affordable access to preventive care are more likely to use the emergency room as their primary care physician.
In 2014, 7.0% of adults aged 18 to 64 went because they had no other place to go for health care, regardless of health insurance status, while 77% went to the ER due to the seriousness of the problem (this includes those who were sent by their doctor). And 15.4% of uninsured adults are more likely to use the emergency room due to a lack of access to other providers.
Impact of Preventive Care on Health Care Costs
Four out of the five leading causes of death are caused by chronic diseases that are either preventable or likely to be manageable with regular access to health care:
- Heart disease
- Chronic lower respiratory disease
Heart disease and strokes are primarily caused by poor nutrition and obesity. Lung cancer, the most common type, is primarily caused by smoking and genetic factors. Obesity is also a risk factor for other common forms of cancer.
Even before they reach emergency room status, these chronic diseases are expensive to treat. In the United States, 90% of the $4.1 trillion in annual health care expenditures are for people with chronic and mental health conditions.
Patients without preventative care or prescription coverage can't afford the treatments, screenings, doctor visits, or medications needed to manage these conditions. When they cut back, they wind up in the emergency room with heart attacks, strokes, and other complications.
When patients have regular access to affordable preventative care, their chronic conditions are more likely to be discovered and managed. This lowers the likelihood of both emergency room visits and more expensive treatments for diseases that have progressed past regular management.
When these decrease, the overall cost of health care decreases for everyone because hospitals are not trying to cover the cost of treating uninsured patients.
The ACA Relies on Preventive Care to Cut Costs
The Affordable Care Act (also known as the ACA or Obamacare) requires insurance companies, Medicare, and Medicaid to provide preventive care services for free. All procedures recommended by the U.S. Preventive Services Task Force have no copay and are included as part of the 10 essential benefits.
The ACA's preventive care provisions include:
- Preventative and wellness visits
- Maternity and newborn care
- Mental and behavioral health treatment
- Prescription drug benefits
- Lab tests that diagnose disease
Maternity and Newborn Care
This includes well-woman visits, domestic violence screening, support for breastfeeding equipment, and contraception.
This is considered cost-saving preventive care because it's cheaper to provide good care for pregnant women and newborns than to treat pregnancy complications or preventable premature births.
Mental and Behavioral Health Treatment
Many homeless people in America have untreated mental and behavioral health problems.
In 2020, there were 580,466 people experiencing homelessness. Of these, 250,000 or 45% were dealing with mental illness. Left untreated, these conditions increase the need for expensive emergency rooms, police action, and jails.
A homeless person visits the emergency department an average of 5 times each year, costing taxpayers an average of $18,500.
Diagnostic Lab Tests
These must be covered 100% if diagnostic as they are considered preventive. If you've already been diagnosed with a disease, your regular copays and deductibles will apply.
Dental and vision care must be covered for children.
All plans listed on the exchanges will include coverage of at least one drug in every category in the U.S. Pharmacopeia. Whatever you pay out-of-pocket for drugs will also count toward your deductible. This is not true though for all insurance plans prior to the ACA.
Frequently Asked Questions (FAQs)
What is covered under preventive care?
Preventive care under the Affordable Care Act covers health care services that are aimed at preventing disease. It covers screenings for alcohol misuse, blood pressure, colorectal cancer, diabetes, high blood pressure, hepatitis C, HIV, lung cancer, obesity, syphilis, tobacco use, and tuberculosis. It also covers vaccinations for diseases including chicken pox, influenza, measles, mumps, and tetanus. There is also preventive care especially for women, which includes breast cancer screenings and well-woman visits. Preventive care for children also includes behavioral assessments, fluoride treatments, and vision and hearing screenings.
How does preventive care lower costs?
Left unchecked, disease and illness can result in poor health, chronic problems, and even death. Preventive care aims to help patients detect health problems and make lifestyle changes that prevent the development of serious disease, which is expensive to treat—costing the American economy trillions of dollars per year.