Preventive care is crucial for early detection of health issues before they become serious. Medicare Advantage preventive care includes exams, vaccines, health screenings and lab tests in addition to the Medicare annual wellness visit and your one-time Welcome to Medicare visit.

If you have Medicare, preventive care is always covered. Medicare Advantage plans often have other benefits you can use to support your well-being, too, for things like dental visits and eyeglasses. Here’s how you can get the most out of your plan’s preventive care benefits.

What is Preventive Healthcare?

Preventive healthcare is a multi-pronged approach to preventing serious health problems in the future. Elements of preventive healthcare include screenings, vaccines, counseling and healthy lifestyle changes.

Medicare Advantage preventive care takes a proactive approach to preventing serious illnesses and chronic conditions. This goes beyond regular health screenings for serious diseases. Immunizations that are less frequent, like Hepatitis B, and shots that require updates, like the flu and COVID vaccines, are included in preventive care coverage. Since diet, physical activity and other habits have long-term impacts on one’s health, preventive care also includes counseling for nutrition, smoking cessation and alcohol misuse.

Preventive Care Benefits in Medicare Advantage

By testing for various diseases on a regular basis, your healthcare provider can form a treatment plan before a health problem has a chance to get worse. Medicare Advantage preventive screening guidelines include the following annual screenings:

• Cardiovascular disease
• Diabetes
• Depression
• Glaucoma
• HIV
• Lung cancer
• Colorectal cancer
• Mammograms
• Prostate cancer
• Sexually transmitted infections

Are You Up to Date on Your Preventive Care?

Preventive care is often overlooked. The National Institute of Health estimates that only 8% of Americans engage in routine preventive care, like up-to-date immunizations and cancer screenings. Getting regular health screenings, updating immunizations when needed, and engaging in healthy habits save money in the long run. If a serious disease can be detected early, this vastly reduces the likelihood of needing expensive surgeries and treatments later in life. Chronic conditions, such as diabetes, can be manageable. However, without testing and ongoing monitoring recommended by your healthcare provider, a manageable condition can become devastating if left unchecked.

Tips for Navigating Preventive Healthcare

When navigating your options for preventive care, you will need to check which providers in your area participate in your Medicare Advantage plan. When choosing a plan, it is best to find out beforehand if your preferred providers participate. While all Medicare Advantage plans cover the same core preventive care services, each plan varies by location and Star Rating.

To get the most out of your Medicare Advantage preventive care benefits, examine your plan documents to see which types of preventive care are covered and compare them to what your healthcare provider recommends. Your provider may offer additional preventive care services you were not aware of or direct you to a participating provider in your network. Your Medicare Advantage plan may offer reimbursement for programs, counselors, tests and devices, making it crucial to read your plan documents thoroughly.

There may be additional resources for free health screenings and other preventive care services where you live. State and local departments of aging and public health may offer these services directly or through participating providers and community health initiatives, such as free vaccines and Silver Sneakers programs. 

Preventive Visit vs. Diagnostic Visit

What’s the difference between a preventive visit and a diagnostic visit? The purpose of a preventive visit is so that you may get screenings, tests, and vaccinations, and you can discuss preventive healthcare options with your provider. Regardless of the outcome of your screenings, preventive visits center these measures to safeguard your health when you otherwise feel fine. Your annual physical and Welcome to Medicare visit are considered preventive visits for this reason.

A diagnostic visit is when you see your healthcare provider because you have symptoms, abnormal test results and/or risk factors for a serious condition. The goal of the visit is for your healthcare provider to make a diagnosis, which can include ordering additional tests, asking you to monitor metrics like blood sugar or heart rate, and arranging follow-up visits. 

Diagnostic visits are reactive because you are experiencing symptoms or an issue was detected in your screenings. Preventive visits take place when you don’t have any reason to believe you have health problems because you don’t feel sick.

	Preventive Visit	Diagnostic Visit
Purpose	Routine screenings, tests, vaccination, discussing preventive healthcare options	Diagnosing symptoms, abnormal test results and/or risk factors for a serious condition
Occurrence	When feeling fine, regardless of screening outcomes	When experiencing symptoms or an issue detected in screenings
Focus	Safeguarding health, proactive measures	Making a diagnosis, reactive measures
Tests and Procedures	Routine screenings, vaccinations	Additional tests, monitoring metrics like blood sugar or heart rate
Follow-up	Generally routine or preventive actions	May include further tests, treatment plans or monitoring
Importance	Preventing catastrophic health issues before they start	Addressing current health concerns and conditions
Cost Savings	Long-term savings, avoiding future health issues	Immediate and potential long-term savings through early detection

By being proactive about preventive care, you can stop catastrophic health issues before they start. Not only does this lead to long-term savings, it may enable you to have a longer and happier life.

For more information on how you can utilize preventive care services with a Medicare Advantage plan, or to learn about Baylor Scott & White Health Plan Medicare Advantage plans, call 1.800.782.5068 (TTY: 711).