3 min read

The Emphasis On Preventive Care

Jul 16, 2013 6:35:00 AM

Preventing disease is important to leading a healthy life. Detecting disease early is a key component to disease management and recovery. As Ben Franklin said “an ounce of prevention is worth a pound of cure”.

Achieving this “pound of cure” will be easier now than ever before with the new provision in the Affordable Care Act that requires insurance policies to include a set of preventive services at no cost to the insured.

Definition Of Preventive Care
Preventive care is defined as medical care that seeks to prevent illnesses. Generally, preventive care includes routine physicals, immunizations, screenings, and counseling designed to help you get healthy and stay healthy!

Accepted Preventive Treatments
The new law expands the definitions of routine care for children to include additional screenings such as behavior and developmental tests as well as Hepatitis B vaccines. Within the last year the new Women’s Preventive Care Enhancements must be included in all non-grandfathered individual and group plans. This expands coverage to evidence-informed preventive care and screenings, and includes some coverage for contraceptives.

As with any coverage, you must verify with your own provider as to their approved list and method of delivery of covering these types of services.

According to www.healthcare.gov, the list of preventive services includes:

For all adults:
Screening for blood pressure, cholesterol, colorectal cancer, depression, diabetes, HIV, sexually transmitted diseases, alcohol misuse, and tobacco use are included.

Immunization vaccines for adults (doses, recommended ages, and recommended populations vary) for Hepatitis A and B, Herpes Zoster, Human Papillomavirus, Influenza (flu shot), Measles-Mumps-Rubella (MMR), Meningococcal, Pneumococcal, Tetanus-Diphtheria-Pertussis(Tdap) and Varicella.

Additional services for women includes screenings for:
Anemia, mammograms, breastfeeding support/counseling, cervical cancer, specifically defined sexually transmitted diseases, domestic/interpersonal violence, Human Papillomavirus (HPA), osteoporosis.

Some coverage for FDA approved contraceptive care is included. (refer to your insurance provider for the list of accepted and covered contraceptive; does not apply to exempt religious employers)

Coverage for children’s preventive health services:
Autism, behavioral assessments (limited within certain age-brackets), depression, developmental (children to age 3), height/weight BMI measurements (within certain age-brackets), lead testing, obesity, oral health risk assessment (to age 5), sexually transmitted diseases, and vision screenings are included.

Are These Preventive Services Really Working?
According to a 2012 press release from the CDC, "Clinical preventive services prevent heart attack, stroke, cancer, and other diseases and save lives," said CDC Director Thomas R. Frieden, M.D., M.P.H. Referring to the continued tracking of preventive services among U.S. adults, he states "As we look to the future, we can track how our nation’s health is progressing through better prevention in health care."

Most recent studies have stated that with the increase in the use of preventive care benefits, the costs will spike over the next several years. According to a 2010 study by the state of Florida, although it is too soon to determine if, from a cost-savings standpoint, preventive services will eventually lead to future savings, “Good value can be defined as providing substantial health benefit per dollar spent net of any savings, without necessarily saving money.”

Putting it into the human cost perspective, they go on to state “Services that have the potential to save the most life-years are the childhood immunization series, smoking cessation advice and assistance, discussion of daily aspirin use to prevent cardiovascular disease, and breast and colorectal cancer screening.”

The logical assumption here is to agree with Ben Franklin – spend an ounce on prevention today, reap a pound of cure for tomorrow!

Controlling Cost of Health Care Spending


Written by Gibson

Gibson is a team of risk management and employee benefits professionals with a passion for helping leaders look beyond what others see and get to the proactive side of insurance. As an employee-owned company, Gibson is driven by close relationships with their clients, employees, and the communities they serve. The first Gibson office opened in 1933 in Northern Indiana, and as the company’s reach grew, so did their team. Today, Gibson serves clients across the country from offices in Arizona, Illinois, Indiana, Michigan, and Utah.