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Preventive Care

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Understand Preventive Care

Commonly known as your annual checkup or physical, preventive care can help keep you from having health problems or catch a possible problem early. But while it's an important part of your health, a lot of people are confused: What exactly is preventive care? Read on to learn what services are considered preventive and how your health plan covers these services.



Preventive Versus Non-Preventive Services

When you visit a network provider, your plan covers preventive services at 100%. On the other hand, for most non-preventive services, you'll pay a share of the costs. The table below shows the differences between these two types of services.

For your information: The Affordable Care Act defines what's considered preventive care. Learn more on HealthCare.gov 

Are you a Medicare member? Learn about preventive and screening services on Medicare.gov 

 

Preventive Services 

 Non-Preventive Services

What is it? 

Preventive services generally:

  • Help keep you healthy
  • Screen for certain types of cancer
  • Immunize you against disease
  • Are received annually, or as recommended by your doctor

Non-preventive services generally:

  • Monitor existing conditions
  • Diagnose and treat a new condition
  • Address any health concerns you bring up during your visit
 

Examples

  • Most immunizations
  • Well-child visits
  • Prenatal care
  • Screenings for cancer such as:
    • Breast (mammogram or 3-D mammogram)
    • Cervical (Pap smear)
    • Colon (colonoscopy, CT colonography or other tests)
  • Screenings for health concerns such as:
    • Blood pressure
    • Cholesterol
    • Sexually transmitted infections (STIs)
    • Type 2 diabetes
    • Depression
    • Tobacco use
    • Alcohol misuse
    • Domestic violence

 

  •  Treatment of illness or injury (e.g. earache, sore throat, cough, broken bone, etc.)
  • Earwax removal
  • X-rays
  • Medication consultation
  • Wart removal
  • Monitoring ongoing conditions such as:
    • Headaches 
    • Trouble sleeping
    • High blood pressure
    • Diabetes
    • Heart conditions
  • Lab tests to monitor existing conditions


Common Questions

What if I receive preventive and non-preventive services during one visit?

If you receive both types of care (preventive and non-preventive) at your visit, the preventive services will be covered at 100%. Depending on your plan, you may pay a share of the costs for the non-preventive services.

How do I determine my share of the costs for non-preventive services?

To learn what your share of the costs may be for non-preventive services, call Medica Customer Service at the number on the back of your ID card, or check your policy of coverage by visiting your secure member site.

Find my secure member site >

 


Medica is a Cost and HMO-POS plan with a Medicare contract. Enrollment in Medica depends on contract renewal.

Medica DUAL Solution is a health plan that contracts with both Medicare and the Minnesota Medical Assistance (Medicaid) program to provide benefits of both programs to enrollees. Enrollment in Medica DUAL Solution depends on contract renewal.


Last Updated: April 2018

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