Key takeaways

  • Preventive health involves services that screen and identify health issues before you experience symptoms.
  • Most insurance plans, including private insurance and Medicare, cover preventive services. You usually do not need to pay out of pocket for preventive care.
  • Preventive tests are different from diagnostic tests. A test is considered diagnostic if a doctor orders it because of symptoms you may have. Preventive tests are routine screenings designed to detect serious health conditions early.

Preventive health refers to the routine care you receive to maintain your health. It also includes screenings for certain health conditions and helps diagnose medical conditions before they become a problem.

Preventing serious diseases before they happen is one of the most important things you can do to protect your health. However, research from 2020 estimates that only 8% of people in the United States received the preventive care recommended to them. Research from 2024 found that preventive healthcare visits and preventive screenings in 2021 and 2022 remained below pre-pandemic levels.

Let’s take a look at what preventive healthcare is, what types of tests, screenings, and services are included, and the role your family history plays when it comes to the preventive tests you may need.

Preventive health encompasses a set of health services meant to screen and possibly identify health issues before symptoms develop. Preventive healthcare can help you live a longer, healthier life.

It is usually administered by a primary care physician (PCP).

Adult preventive healthcare typically includes screenings for conditions like heart disease, diabetes, and cancer, as well as counseling for smoking cessation, if needed, and balanced eating habits. It may also include vaccinations.

For children, preventive healthcare includes yearly checkups, vaccinations, and screenings for conditions like autism and lead poisoning. Children’s preventive healthcare is usually administered by a pediatrician, a doctor who specializes in children’s health, or a family physician, who specializes in comprehensive care for individuals from childhood through adulthood.

Preventive healthcare costs

Most health insurance plans cover the full cost of your preventive health services, with no co-payments. This includes most private health insurance plans and health insurance plans purchased through the Health Insurance Marketplace.

However, if you visit an out-of-network provider, you may have to pay a fee. You can find out if a facility and healthcare professional are covered by your plan by reaching out to your plan administrator or looking at your plan’s website. A plan’s network can change at any time.

Health plans acquired through Medicaid and Children’s Health Insurance Program (CHIP) also cover preventive care, with no co-payments or other costs to you.

Preventive care for adults involves screening for chronic conditions like diabetes and heart disease, and immunizations against serious illnesses like the flu and COVID-19.

It also involves education and counseling that can help you make positive lifestyle choices that protect your overall health and well-being as you age.

The types of screenings recommended for you may vary based on your age, sex, and family history. The following are the most common preventive screenings for adults:

  • Some cancer screenings: Routine screenings for breast cancer, colorectal cancer, cervical cancer, and prostate cancer can help support the detection of these common cancers early, which can stop them from spreading within the body and becoming more serious.
  • Screenings for blood pressure, cholesterol, and diabetes: These screenings can help detect common metabolic conditions that can be treated with medication and lifestyle changes. If not treated, they may lead to serious disease and premature death.
  • Screenings for osteoporosis: An osteoporosis test is typically considered preventive care for people who have begun or gone through menopause.
  • Immunizations: Vaccines recommended for adults can include annual flu shots, COVID-19 vaccines, and boosters for vaccines you received as a child that may have worn off. Doctors may also recommend additional vaccines based on travel to certain areas or other factors.
  • Counseling: Preventive counseling may be available to help reduce your risk of certain chronic conditions. For example, a healthcare professional may recommend a smoking cessation program if you smoke, screen you for mental health conditions, or discuss your eating and exercise habits.
  • Screenings for some sexually transmitted infections (STIs): Depending on your age and other risk factors, some STI screenings may be covered as preventive care, depending on your insurance plan.

Preventive care for children and babies helps protect them from some of the serious illnesses that can affect kids, and includes screenings to detect behavioral and health conditions. Preventive healthcare can help children stay healthy when they’re young and also as they grow older.

Preventive healthcare for children is covered in full under most insurance plans, and is always covered in full by Children’s Health Insurance Program (CHIP).

Some of the preventive care offered to children includes:

  • Well-child visits: These visits happen every few months when your child is an infant, and yearly after that. Well-child visits include measurements of your child’s growth and developmental milestones. Routine immunizations and screenings are also conducted during these visits.
  • Vaccinations: Vaccinations for children protect them from serious diseases now and in the future. Routine childhood vaccines include polio, hepatitis A and B, DTaP (diphtheria, tetanus, and pertussis), MMR (measles, mumps, and rubella), and chickenpox (varicella).
  • Behavioral and mental health screenings: Pediatricians routinely screen children for conditions like autism, depression, and developmental delays.
  • Blood tests: Various blood test screenings will be conducted throughout childhood, including tests that measure a newborn’s bilirubin levels, look for signs of anemia, and measure the amount of lead in your child’s blood.

You can schedule a well-child visit as a back-to-school checkup. This allows the healthcare professional to complete any necessary forms required by the school, such as immunizations and an annual physical.

Preventive care does not include diagnosis or treatment of existing health conditions.

Testing for a health condition is not considered preventive care if you have symptoms of it or a prior diagnosis. This includes:

  • viral, bacterial, and fungal infections, including sexually transmitted infections
  • diabetes
  • autoimmune disorders
  • cancer
  • injuries

If you receive a test or book an appointment to check for a specific health condition due to symptoms you’re experiencing, it is considered diagnostic and not preventive, even if you ultimately do not receive a diagnosis of that condition.

Visits with specialists to manage or treat an existing health condition are also not considered preventive care.

Preventive tests refer to screenings that detect diseases and conditions before symptoms develop. Diagnostic tests are used to learn more about a condition once symptoms are present.

For example, getting a screening blood test for diabetes when you don’t have any symptoms is considered a preventive test. However, if you’ve already received a diagnosis of diabetes and you get a test to check your blood sugar and A1C, this would be a diagnostic test.

Likewise, getting a routine mammogram is considered preventive care if you don’t have any symptoms of breast cancer. But if you find a lump and then have a mammogram, it is considered diagnostic.

When you have an appointment with your doctor, you may get any number of tests done. Some may be preventive, and others may be diagnostic.

Preventive and diagnostic tests are billed and covered by insurance differently. You typically pay more for diagnostic tests.

Sometimes, genetics can increase the risk of certain health conditions. This might include:

  • having the BRCA gene, which can increase the risk of breast and uterine cancer
  • having Lynch syndrome, which increases the risk of various cancers
  • having genetic mutations that increase the risk of type 2 diabetes

If a close relative (like your mother, father, or sibling) has a health condition, such as diabetes, heart disease, or cancer, you’re considered to have a family history of that condition.

If you are unsure about your family health history, now might be a good time to discuss it with your close family members.

If you find out that certain diseases tend to run in your family, tell your physician about this at your next checkup. They can help you understand which preventive screenings may be appropriate for you, and whether you may need to be screened for these conditions at an earlier age or more frequently than other people.

How family history affects care

Having a family history of a particular condition means that screenings for it are even more important, and you may need early, more frequent, or more robust screening than someone who doesn’t have this same family history. These screenings are still considered preventive care.

Learning that you have a family history of a serious health condition may be discouraging and stressful, but knowledge is power.

While you can’t change your genetic risk, you can participate in health screenings that can detect this condition early, so that treatment is more effective.

Furthermore, when you know your family history, you can take steps to lower your risk of specific conditions. You can be proactive about engaging in healthy lifestyle choices that are known to help prevent these conditions from developing or worsening.

One of the best ways to support your overall health and well-being is to get recommended preventive screenings for serious conditions before they happen. That’s what preventive health is about, and why medical experts recommend that all adults and children participate in routine tests, screenings, and immunizations.

Preventive health services offer significant health benefits and are covered by most insurance companies, including Medicare. Participating in preventive care usually won’t cost you anything.

And if any conditions are identified, early treatment will likely save you money on healthcare costs in the future.

If you have any questions about preventive care and what screenings you or your children should get, be sure to talk with your doctor or healthcare professional.

Preparing for your doctor’s appointment ahead of time can help ensure you get the medical care you need. Consider making a list of any questions or concerns you have and thinking about your desired outcomes in advance. This goes for both in-person and telehealth appointments.