Preventive care is any medical service that protects against or reduces the likelihood of health emergencies. It is covered under the Affordable Care Act and helps keeps healthcare costs low.
Learn more about what counts as preventative care and how this impacts your healthcare and insurance costs.
What Is Preventative Care?
Preventative care is healthcare 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.
Preventative 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 Preventative Care Matter?
Preventive care helps lower healthcare costs in America by preventing or treating diseases before they require emergency room care.
Hospital care is very expensive, making up one-third of all healthcare costs in America. In 2010, 21.4% of adults had one or more emergency room visits. By 2017, that had decreased to 18.6%, before rising again to 21.3% in 2018.
Adults who do not have affordable access to preventative 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 healthcare, 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 lack of access to other providers.
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 healthcare for everyone.
Impact of Preventative Care on Healthcare 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 healthcare:
- 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 $3.5 trillion in annual healthcare 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 healthcare 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 strategy appears to be working. In 2018, a Health Affairs study found states that expanded Medicaid saw a 40% increase in the number of prescriptions filled for diabetes drugs. States that didn’t expand Medicaid expansion saw no increase. Another study, published in 2020, found that the Medicaid expansion was associated with a lower risk of mortality among patients with breast, colorectal, and lung cancer.
A systematic review of available research, conducted in 2020, found that overall, the Medicaid expansion was associated with increases in insurance coverage, quality of care, and use of medical services. It also found that very few studies associated the Medicaid expansion with negative consequences for access to or use of healthcare.
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, and 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.
As of January 2020, 580,466 people were homeless on any given night in the U.S. Of these, 250,000 or 45% were experiencing 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.