The line between preventive and diagnostic medical care can often be blurry. Here’s some information that may help clear things up.
What is preventive care?
Preventive care includes immunizations, lab tests, screenings and other services intended to help you prevent an illness or detect a health issue before you notice any symptoms. Getting the right screening test at the right time is one of the most important things you can do for your health. They find diseases early, before you have symptoms, when they’re easier to treat. The tests you need are based on your age and risk factors. Which screenings should you get? Click here for lists of tests your doctor may recommend.
What is diagnostic care?
Diagnostic medical care is meant to treat or diagnose a problem you’re having by monitoring existing problems, checking out new symptoms or following up on abnormal test results.
What’s the difference?
Essentially, the goal of preventive care is to detect health problems before you have symptoms. Diagnostic care diagnoses or treats symptoms you already have.
Why does knowing the difference matter?
Your insurance coverage may be different depending on the type of services (preventive or diagnostic) you receive. Many preventive services are 100 percent covered — no out-of-pocket cost to you. Diagnostic tests may not be completely covered, which means copays, coinsurance and deductibles will apply. Refer to your benefit plan documents for detailed information on your coverage.
Here are some examples:
- When a 43-year-old woman gets her annual mammogram to screen for breast cancer, it’s preventive care. However, if she noticed a lump in her breast and got a mammogram to evaluate the lump, it’s diagnostic care.
- When a person with no history of high blood pressure gets a routine blood pressure check to screen for high blood pressure, it’s preventive care. If someone with high blood pressure risk factors (like being overweight and smoking) gets their blood pressure checked by their doctor because they’re having early morning headaches (a symptom), it’s diagnostic care.
You may receive preventive and routine care during the same healthcare visit, and the cost of the same test or service may change based on why it’s being done, so be sure to ask your doctor why a test or service is ordered.
These are general guidelines for preventive care — they’re not a replacement for your doctor’s advice. The care you need depends on your current health, family history and other individual factors. Talk to your doctor about the care that’s right for you.
[SOURCES: Medical Mutual / Young Invincibles / HealthCare.gov]