An “ounce of prevention” is one way to say that it is better and easier to stop a problem or illness from happening than to stop, or correct it, after it has started.
Ben Franklin coined this timeless phrase in 1736 in order to remind the citizens of Philadelphia to remain vigilant about fire awareness and prevention. As is true of many of his quotes, it still has great relevance today. Carrie Lukins, RN, BSN, reminds us that healthcare plans offer many preventive benefits, to avoid the need for “curing” more severe ailments down the road.
Many health issues are preventable
Nearly 40 percent of all deaths in the United States are due to behavioral causes, according to CDC data. Identifying and preventing serious and costly chronic illnesses early can help people live healthier lives. Each of us, in partnership with our healthcare providers, can take responsibility and control of our personal health and well-being, simply by being aware of behaviors that lead to greater and chronic health issues and by taking advantage of preventive tests and exams.
Chronic diseases such as heart disease, cancer, and diabetes are the leading causes of death and disability in the United States. They are also leading drivers of the nation’s $3.8 trillion in annual healthcare costs.
Many chronic diseases are caused by a short list of risk behaviors:
- Tobacco use and exposure to secondhand smoke
- Poor nutrition, including diets low in fruits and vegetables and high in sodium and saturated fats
- Lack of physical activity
- Excessive alcohol use
Taking advantage of preventive health services is one way each one of us can really leverage our health plan benefits and avoid potential longer-term health problems. Simple preventive tests offer a wealth of information and can guide you and your doctor to simple treatments that may be inexpensive and provide better health outcomes in the long run.
Insurance offered through your employer may offer more than 70 preventive benefits including screenings, counseling, exams, and immunizations/vaccinations at little to no cost to you. Take these three steps:
- Schedule an appointment with your physician to take advantage of these free services before your plan year ends.
- Make it a part of your annual well-visit to use these services covered under your benefit plan.
- Consider taking greater control of your health by learning more about how to prevent chronic diseases.
Why are preventive services included in your health plan?
Under current ACA provisions, your health insurance company is required to provide preventive services such as screenings, tests, and health evaluations at no cost when you receive care in your specific provider network. Preventive care can help keep people from developing costly chronic conditions that are extremely expensive and difficult to manage.
According to the CDC, chronic diseases that are avoidable through preventive care services account for 75 percent of the nation’s healthcare spending and lower economic output in the United States by $260 billion dollars a year. If everyone in the country received recommended clinical care, then the healthcare system could save over 100,000 lives a year.
For example, by reducing the prevalence of hypertension in our country by just five percent, the national healthcare spend would be reduced by $25 billion. Preventing permanent, long term infections and diseases like HIV/AIDS can also lower spending.
Encouraging the use of preventive services can keep patients healthy, and stop them from getting more complex, difficult to treat chronic illnesses.
What preventive services are covered?
All Marketplace and Affordable Care Act (ACA) health plans, as well as many other health plans, must cover preventive services without charging a copayment or coinsurance. This is true even if you haven’t met your yearly deductible. Here’s a partial list of services, just to give you an idea: (Note: Services are free only when delivered by a doctor or other provider in your plan's network.)
Adult Preventive Services
Screenings:
- Blood pressure screening
- Cholesterol screening
- Colorectal cancer screening
- Depression screening
- Diabetes screening
Immunizations:
- Flu
- Shingles
- Hepatitis
- Tetanus
You can determine which specific preventive benefits are available to you by your age and gender here.
Adults, learn more here.
Preventive care benefits specifically for women
Women can learn more here.
- Services for pregnant women or women who may become pregnant
- Breastfeeding support and counseling
- Birth control
- Gestational diabetes
- Maternal depression
- Urinary tract infection
- Tobacco intervention and counseling
- Other preventive services for women
- Bone density screening
- Breast cancer genetic test counseling (for women at higher risk)
- Mammography screenings
- Diabetes screening
- Well-women visits
Preventive care benefits for children
- Screenings for Children
- Alcohol, tobacco, and drug use assessments for adolescents
- Depression screening for adolescents
- Height, weight, and body mass index (BMI) measurements
- HIV screening
- Immunizations
- Chickenpox
- Diphtheria, tetanus, and pertussis
- Flu shot
- Measles
- Mumps
- Pneumonia
- Rubella
Also, vision screening, well-baby, and well-child checkups are covered.
Learn specifically about preventive services for children and specific age groups here.
What services are covered for PHP members?
To be certain of services that are covered for PHP members, always rely on the PHP member website. You can access your preventive benefits, specifically by plan type, your age, and gender by logging into the website and navigating to the preventive benefits page. And, once logged in, you’ll have the added benefit of using the “live chat” feature if you have additional questions.
Don’t leave health benefit money unused
Remember, many screenings and tests are done annually. Take full-advantage of your health plan by using the benefits that are offered to you. Employers, consider allowing time off work for employee well-visits. In the long run, employees, employers, and our community will benefit from better overall physical and mental health.
