What Is Preventative Care Insurance?

What Is Preventative Care Insurance?

Did you know that a regular routine appointment with a primary care doctor, without any other tests involved, can cost anywhere from $150 to $300? This is why most Americans fail to get regular checkups and end up with illnesses that could have been avoided. 

But what if you didn’t have to pay such amounts out-of-pocket? This is possible if you have preventative care insurance (PCI), and this article will tell you all you need to know about it. 

Understanding Preventative Care Insurance 

Preventative care insurance is coverage under a standard health insurance policy that pays for the care received to prevent the occurrence of an illness. The Affordable Care Act (ACA) mandates insurance companies to cover all preventative doctor visits and exams at no cost to the patient. 

This means an insurer cannot charge additional fees for preventative care coverage. Also, insurance companies cannot impose cost-sharing, like copayments, deductibles, or co-insurance, on patients receiving preventative care services. However, ensure you check the terms of your policy to ensure it includes preventative care and covers 100% of costs. 

What Qualifies as Preventative Care? 

The ACA states what qualifies as preventative care. They include the following:


Preventative care insurance covers the screening of certain health conditions for adults and children, and illnesses or conditions specific to women. These includes:

  • Blood pressure screening 
  • Hepatitis B screening 
  • Abdominal aortic aneurysm 
  • Breast cancer mammogram screening 
  • Gestational diabetes screening for women 24-28 weeks pregnant, or those at high risk of developing gestational diabetes
  • Autism screening 
  • Developmental mental screening for children under the age of 3, etc.


PCI pays for medications that prevent certain illnesses. For example, PCI will pay for aspirin if your doctor prescribes it for preventing cardiovascular disease or blood clots. 


If you need immunization for Hepatitis A and B, influenza, human papillomavirus, or whooping cough, preventive care insurance will pay for it. 


Finally, PCI pays for counseling to prevent the recurrence of an illness or addiction, for example, alcohol misuse counseling. 

Note that preventive care insurance does not pay for diagnostic care. This is because it is a service where the doctor wants to find out more about something, not prevent it. 

At Goldstein Healthcare, we will help you purchase the right health insurance plans for you and your family, so you don’t have to worry about being able to pay for preventative care services or going for routine checkups. Learn more here about all of Goldstein Healthcare’s services.