Preventive services

Health insurance plans provide a number of preventive services that many employees don’t know are available, and some simply don’t use.

What if people took advantage of the preventive services that are included in their health plans?

For one, we’d be staying healthier and living longer. Each year, millions of people die preventable deaths. A 2004 study showed that about half of all deaths in the United States in 2000 were due to preventable behaviors and exposures1.

Second, employers would likely experience an increase in productivity. Because health problems impact productivity, they are a major drain on the economy, resulting in 69 million workers reporting missed days because of illness each year. This loss of productivity reduces economic output by an estimated $260 billion per year.

Preventive services are designed to ensure we stay as healthy as possible and stop small problems from becoming large ones. With better health comes fewer days of missed work and an overall higher level of workplace productivity.

So where do we begin? One place to start is to remind employees what preventive services are, and that many of these services are included in their health plans (aka “free”).

Preventive medicine includes regular check-ups, patient counseling, and health screenings that can help prevent illness, disease and other health-related problems. The prices of medical services and tests are difficult to gauge precisely, because the costs associated with them vary widely throughout the country. There is certainty, however, that such services are cost effective given they help save time, money and lives.

The medical community recommends adults and children visit their doctors for regular check-ups — even if they feel healthy — for disease screenings, identifying risk factors for disease, discussing tips for a healthy and balanced lifestyle, keeping up to date on immunizations and boosters, and maintaining a good relationship with a health care provider.

Wellness exams

An annual wellness exam or physical allows you and your primary care doctor to discuss your overall health and talk about any changes that should be made related to your lifestyle, prescription medications or treatment plans for existing health conditions.

A routine physical should include height, weight and blood pressure measurements; a head-to-toe exam that includes listening to your heart and lungs, checking your ears, nose and throat, and assessing your skin; and updating your health history. Depending on your gender, age, family health history and other risk factors, your doctor may perform additional examinations or order laboratory tests.

Immunizations

Most preventive services include immunizations, such as flu shots, and are provided at no charge to the insured if you use an in-network provider. Doctors suggest annual flu shots for children and seniors, as well as adults who have respiratory conditions such as chronic bronchitis or have had pneumonia. They are usually no additional cost if conducted in your doctor’s office, and insurance will cover them if received at a pharmacy or drug store. Other recommended immunizations include vaccines for pneumonia and shingles, the latter for seniors who had chicken pox as children. At your next checkup, you can ask your doctor if you’re up to date on your recommended immunizations.

Screenings

Some common health screenings include: hypertension (high blood pressure); hyperglycemia (high blood sugar, a risk factor for diabetes mellitus); hypercholesterolemia (high blood cholesterol); HIV and other sexually transmitted diseases including chlamydia, syphilis and gonorrhea; breast, colorectal, cervical and prostate cancers; depression; and osteoporosis.

Genetic testing can also be performed to screen for mutations that cause genetic disorders or predisposition to certain diseases, such as breast or ovarian cancers.

An eye on health

A comprehensive eye exam by an optometrist or ophthalmologist will include an assortment of tests to evaluate vision and eye health. You and your eye doctor will also discuss your health history and any vision or eye health concerns you may have. Eye health can be indicative of diseases and health problems such as diabetes and high cholesterol.

The American Optometric Association recommends an eye exam every two years for asymptomatic or risk-free children ages 6 to 18, and adults ages 18 to 60. Adults 61 and older, as well as at-risk children and adults, should visit the eye doctor annually. For children younger than 6, the AOA advises an eye exam at 6 months and 3 years and more frequently as recommended.

Do yourself a favor

Americans use preventive services at about half the recommended rate, according to the Centers for Disease Control and Prevention. Cost-sharing such as deductibles, co-insurance or copayments were among reasons cited by the CDC. So, too, was the failure to see a doctor regularly.

People who don’t use preventive services are doing themselves a financial disservice because they are essentially paying for them through insurance premiums each year. Although you don’t pay cost-sharing charges when you receive preventive care, the cost of those services is wrapped into the cost of your health insurance. This means the use of preventive care is being paid for whether or not they choose to pursue the recommended preventive care — so they might as well take advantage.Reminding them of this often is key.

1. Mokdad, Marks, Stroup and Gerberding, 2004

It's to your advantage

Making the most of your preventive benefits includes getting screened for ailments such as communicable diseases, STDs and cardiovascular problems. You can also be assessed for personal issues such as substance abuse and mental illness. Other benefits covered under preventive care are osteoporosis screenings for at-risk women, and services for women who are pregnant or breastfeeding.

Recommended infectious disease prevention measures:

  • Hepatitis C screening one time for anyone born 1945 to 1965 and for any adult at high risk
  • Hepatitis B screening for pregnant women at their first prenatal visit
  • HIV screening for anyone between ages 15 to 65, sexually active individuals and others at high risk
  • Syphilis screening for adults at high risk and all pregnant women
  • Chlamydia screening for young women and women at high risk
  • Gonorrhea screening for women at high risk
  • Sexually transmitted infection prevention counseling for adults at increased risk
  • Obesity screening and counseling
  • Diet counseling for adults at high risk for chronic disease
  • Routine immunizations for adults, depending on age, for:
  • Hepatitis A
  • Hepatitis B
  • Herpes Zoster (shingles)
  • Human Papillomavirus (HPV)
  • Influenza (flu)
  • Measles, Mumps, Rubella
  • Meningococcal
  • Pneumococcal
  • Tetanus (lock jaw), Diphtheria, Pertussis (whooping cough)
  • Varicella (chicken pox)

Recommended cardiovascular disease-related preventive measures:

  • Cholesterol screening for high-risk adults and adults of certain ages
  • Blood pressure screening
  • Type 2 diabetes screening for adults with high blood pressure
  • Abdominal aortic aneurysm screening one time for men who have smoked
  • Aspirin when prescribed for cardiovascular disease prevention at certain ages

Recommended substance abuse prevention measures:

  • Alcohol misuse screening and counseling
  • Tobacco use screening and cessation intervention for tobacco users

Other Preventive Services

  • Depression screening
  • Domestic violence and interpersonal violence screening and counseling for all women
  • Osteoporosis screening for women over 60 based on risk factors
  • Well-woman visits for women under 65
  • Contraception for women with reproductive capacity as prescribed by a health care provider — this doesn’t include abortifacient drugs: doesn’t apply to health plans sponsored by exempt religious employers

Preventive services for pregnant or nursing women:

  • Anemia screening
  • Breastfeeding support and counseling, including supplies
  • Folic acid supplements for pregnant women and those who may become pregnant
  • Gestational diabetes screening at 24 and 28 weeks gestation and those at high risk
  • Hepatitis B screening at first prenatal visit
  • Rh incompatibility screening for all pregnant women and follow-up screening if at increased risk
  • Expanded tobacco counseling
  • Urinary tract or other infection screening
  • Syphilis screening