Healthcare doesn’t just mean reactive treatments and procedures, although these are essential when you’re ill or injured. Preventive care is a generalized term for all aspects of healthcare that boost your overall well-being, from standard vaccinations to mindfulness for mental health. Many insurers are now promoting medical plans that include preventive care to improve wellness, and some aspects of preventive care are required by the Affordable Care Act (ACA).
Understanding how preventive care is changing medical plans can help businesses pick the right plans for their employees and create a healthier workforce.
Screenings and Vaccinations
Some of the most basic aspects of preventive care are regular screenings for diseases like cancer and vaccinations recommended by the Advisory Committee on Immunization Practices (ACIP). These actions help protect over 150 million Americans — including 37 million children — from diseases and conditions including:
- Hepatitis B
- Rotavirus
- Diphtheria
- Tetanus
- Acellular pertussis
- Influenza (the flu)
- Polio
- COVID-19
- Measles
- Mumps
- Rubella
While insurers are currently required to cover these forms of preventive care at no extra cost to the client, it makes sense to continue to do so even if those laws change. An adult who develops an easily prevented condition will cost insurers a lot more if the provider has failed to cover an inexpensive screening or vaccination earlier in their relationship with that client.
Annual Wellness Exams
Another aspect of preventive care is an annual check-up to catch any health issues you may not have seen a doctor about — or may not even realize are problematic. Examining a new mole, for example, could result in a minor treatment that prevents serious and life-changing cancer treatments later down the line. Some medical plans offer annual wellness visits (AWVs) in conjunction with Medicare once the individual has had Medicare for 12 months.
Counseling and Education Services
Under the ACA, all marketplace medical plans should now include mental healthcare benefits. Compliant plans should offer:
- Counseling
- Psychotherapy
- Behavioral services
- Substance use disorder treatment
Medical plans must now cover pre-existing conditions so that those who have had long-term struggles with mental health aren’t left behind. Currently, employees can miss more than 11 working days each year due to untreated mental health concerns. Insurers who support mental health also support the economy by helping get people back to work — and enjoy all the other aspects of their lives.
Health education services are another aspect of preventive care that can cost insurers very little. Setting up an educational website or app, for example, requires an initial layout but then potentially minimal costs to keep the information updated. Clients can access useful tips on nutrition, exercise, mindfulness, stress reduction, and other ways to improve their wellness without seeking chargeable medical assistance.
Preventive Care Incentives
Wellness can be incentivized at both an individual and national level. Ten states currently participate in an incentive program that provides grants to those states if they encourage Medicaid beneficiaries to take part in wellness programs, including:
- Tobacco cessation
- Weight loss or control
- Blood pressure reduction
- Diabetes avoidance or management
Private insurers may also offer financial benefits and vouchers directly to their clients for hitting preventive healthcare goals. Research shows that these incentives are particularly effective for high-risk and low-income individuals and communities.
Early Detection Benefits
By incentivizing wellness and providing preventive care benefits, there’s a higher chance of stopping disease before it occurs and of spotting problematic symptoms as early as possible via screenings and wellness visits. Cancer screening experts, for example, state that positive patient outcomes are far more likely when tumors are discovered early.
An individual who can’t afford these screenings could end up requiring invasive and expensive medical procedures and even be at risk of death. Insurers who cover routine exams as standard help protect the health and life of more patients and reduce strain on the overall healthcare system.
Medical Plans That Bolster the Health of the Nation
Insurers benefit from promoting preventive healthcare services because the healthier their clients are, the lower the risk they have to pay out. However, these benefits are mutual. Clients are covered by their insurance but also live healthier, happier lives if they take advantage of the preventive care options included in medical plans. Plus, as insurers save money by bolstering the health of their client base, there’s every opportunity to pass some of those savings onto the end user.
As we move into 2025 and beyond, expect hiring trends in the health insurance sector to lean toward recruiting preventive care experts to further expand the benefits on offer.
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