Preventive Care versus Diagnostic Care: What’s the difference? And how might my out-of-pocket cost change?

| Posted On Aug 14, 2017 | By:

In most instances, health insurance plans cover preventive care and you don’t pay anything for these services.  But depending on your health plan, you may have to pay something for diagnostic care.  And if both preventive and diagnostic care are provided by a clinician during the same visit (for example, during a routine physical), you may have to pay some portion (such as a copayment, deductible, or co-insurance) for the diagnostic services.  As coverage varies greatly among different insurance plans, we recommend that you understand what your specific plan considers preventive and diagnostic care and what you may be responsible to pay out-of-pocket for these types of services.  See the definitions below and then some common examples which illustrate how your health insurance plan may – or may not – cover different types of care.

Definitions

Why it matters?

In most cases, you don’t pay anything for preventive care. But you may have to pay something for diagnostic care. And if both preventive and diagnostic care occurred at the same visit, you will likely have to pay a copayment, deductible, or co-insurance for the diagnostic services. We recommend that you always confirm with your health plan what your coverage is for both preventive and diagnostic care. See below for examples.

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