By now, many consumers know that
health insurance plans
are required by law to
100 percent of the costs for preventive care. However, a question we often
hear is, “What is preventive care?”
is the care you receive to prevent illness or disease. It also includes
counseling to prevent health problems. Providing these services at no cost
is based on the idea that getting preventive care, such as
immunizations, can help you and your family stay healthy. Preventive care may also help
reduce your health care costs down the road if you catch a problem early,
or if an
immunization keeps you from getting a serious illness.
Here are a few examples of what’s covered, plus tips to help you know what
to expect. Preventive care services include:
• Wellness visits
and standard immunizations
• Screenings for blood pressure,
cholesterol, depression, obesity, and Type 2 diabetes
• Pediatric screenings for hearing, vision, autism and developmental
disorders, depression, and obesity
There are also certain
recommended preventive services and immunizations
based on your gender and age. Check out the full list of
preventive care services.
Is there ever a chance you might have to pay?
Many preventive services are 100 percent covered by insurance. For example,
if you have an IBX plan, you won’t have to pay anything for these services
if you see a doctor or health care professional within our network.
There is a chance that you may still be asked to pay after a visit for
additional services, so be sure to consider the following:
- It’s important to make sure that you and your doctor are on the same
page. Always ask what services your doctor is providing. What you pay will
also depend on how he or she bills your health insurer.
- If a preventive screening uncovers something that could be serious, your
doctor may order additional tests, schedule a follow-up visit, or refer you
to a specialist. The additional tests and follow-up may not be 100 percent
- If a preventive screening uncovers something that your doctor says needs
to be addressed right away, then that visit may switch from being
considered preventive to treatment. Also, if you see a doctor to diagnose,
monitor, or treat an illness or injury, the visit is not considered
preventive care. In these cases, your normal
would apply (copayments, coinsurance, or
- There may be limits on the number of preventive services you can receive
with no out-of-pocket cost. For example, in some plans, a wellness exam may
be 100 percent covered once every other year. However, if you get a checkup
more often, your normal member cost-sharing fees may apply.
In any case, it’s always a good idea to
check with your insurance company
ahead of time on the services that will be covered.
What If you are charged for a preventive care service?
Be sure to keep your paperwork and bills handy. If you’re charged for a
service you believe should have been 100 percent covered, here’s what you
- Check with your doctor’s office. Ask what services were billed to the
insurance company. Does it match what you remember from your visit? If it
turns out there was a mistake, the doctor’s office can send a corrected
claim to the health insurance provider.
- Check with your health insurer. Ask what services the doctor’s office
billed. Does it match what you remember from your visit?
- Ask your doctor for a reimbursement. If your doctor agrees that a
mistake was made with your bill, ask your doctor to reimburse you the
appropriate out-of-pocket expense.
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About the IBX Insights Team
The IBX Insights Team is here to provide tips on using your health
insurance and living a healthy life.