6 Common Questions About Preventive Care

03/15/2022 by Sarah Pena

Preventive care is a top priority at North Country HealthCare due to its critical role in safeguarding a patient’s overall health. Routine wellness exams help identify health risk factors and allow for timely intervention. A wellness visit is key to combating most lifestyle-related conditions such as stroke, diabetes, heart disease and hypertension.

To help you make the most of your health insurance, we answered six commonly-asked questions about preventive care and how it works.

1. Are wellness exams covered by insurance?

Yes! Health plans are required by law to cover the tab without charging you a co-payment or deductible when you visit an in-network provider for a preventive healthcare visit. This is applicable even when you haven’t met your yearly deductible.

When the Affordable Care Act was passed in 2010, it required that all health insurance plans include ten “essential health benefits,” in order to protect the health of Americans of all ages. These essential services are required to be covered by both private insurance plans (such as those from an employer or the Health Insurance Marketplace) and public insurance plans (such as Medicaid, Medicare or Children’s Health Insurance Plan). Those ten essential benefits include:

• Ambulatory, or outpatient care
• Emergency services
• Hospitalization
• Laboratory services
• Mental health and substance use disorder services
• Pediatric services, including dental and vision care
• Pregnancy, maternity, and newborn care
• Prescription drugs
• Preventive and wellness services and chronic disease management
• Rehabilitative and habilitative services and devices

2. What wellness exams do I need?

The preventive care services you need depend on various factors such as your age, gender, family history and personal risk factors.

Here are some examples of what your check-up could include:

• Wellness exam once per calendar year with your primary care provider
• Recommended vaccines, including one flu shot per year
• An annual mammogram, usually after the age of 40
• A colonoscopy typically once every 10 years, starting at age 50
• Childhood vaccinations and boosters such as measles, mumps, rubella and polio

3. What can I expect at a wellness visit?

A wellness visit at North Country HealthCare can provide several insights into your overall health. Your physician will evaluate your current health status and discuss any concerns you may have. A typical wellness visit evaluates your weight, blood pressure, cholesterol levels and nutrient deficiencies, as well as your risk for certain conditions or prevailing health issues. Based on the outcome, you and your physician may develop a custom plan to improve your health. A typical visits usually takes 30 minutes to an hour, depending on what care is needed.

4. What types of actions might my doctor recommend?

Sometimes, a simple lifestyle change is all it takes to drastically improve your health and avoid diseases that can lower your quality of life. Unhealthy behaviors such as poor diet, sedentary lifestyles and tobacco use increase the likelihood of developing conditions such as heart disease, diabetes, obesity, and some types of cancer. Research indicates that cardiovascular disease affects many people in Arizona. The condition, which includes stroke and heart diseases, accounts for 30% of the state’s mortality rate. About 4.2% of people in Arizona live with a heart condition, while 2.5% live with cerebrovascular disease, which can cause a stroke. These conditions are largely preventable with early intervention and lifestyle changes.

5. What if I have Medicare?

Medicare allows you to choose between two primary ways to get your coverage. You can opt for Original Medicare (Part A and Part B) or Medicare Advantage Plan (Part C). You can opt for Medicare supplement insurance, called Medigap, or Medicare drug coverage if you need additional coverage.

Medicare Part A covers hospital insurance, while Part B covers most outpatient and preventive care. Medicare Part B includes a “Welcome to Medicare” preventive care visit to a health facility that accepts assignment within the first 12 months of starting coverage.

The “Welcome to Medicare” preventive visit includes a review of your medical and social history, education and counseling about preventive healthcare services. That may include:

• Screenings, flu and pneumococcal shots, and additional referrals, if necessary
• Measurements of your blood pressure, weight and height
• Body mass index calculations
• Vision tests
• Mental health and wellness assessment
• A detailed health plan with the shots, screenings and preventive services you need

For your scheduled “Welcome to Medicare” preventive visit to North Country HealthCare, you should bring:

• Medical and immunization records
• Family health history
• A list of any over-the-counter and prescription drugs, supplements and vitamins you take

6. What if I have Medicaid?

Patients covered by the Arizona Health Care Cost Containment System (AHCCCS), Arizona’s Medicaid agency, are also entitled to free preventive care visits at our facilities. The state agency’s health plan functions like a health maintenance organization (HMO) and contracts various health care providers to offer covered services.

Approved members only need to pick a health plan covering their zip code for approval. After you’re approved, you can select North Country HealthCare as your primary care provider.

With your AHCCCS insurance, you’re covered for various services, including:

• Doctor visits
• Physical exams
• Vision exams
• Hearing exams
• Hospital services
• Behavioral health
• Dental care and screenings (for those under the age of 21)

Preventive healthcare services at North Country HealthCare

At North Country HealthCare, we provide various preventive care services to help you lead your best life. Our range of services covers patients of all ages, from toddlers, school-aged children and teens to adults. Whether you need a wellness exam, routine vaccinations or a mental health and wellness assessment, we can help. We also provide professional counseling services to help patients quit smoking, lose weight, overcome alcohol use, embrace healthy eating and overcome depression.

Most of our locations have on-site laboratory services and can quickly perform lab tests, which are crucial in preventive care because they help your doctor detect health problems before they compound. If you need additional screening, your doctor may refer you to another office for specialized services, such as colonoscopy and mammogram.

Don’t have health insurance? At North Country HealthCare, we won’t turn you away based on your ability to pay. We offer a sliding fee scale for those who qualify, which means you’ll only pay a nominal fee for your appointments and services in all our facilities. We also have staff on-site who can help you apply for affordable or no-cost health insurance. To learn more, call the North Country HealthCare location nearest you.

Bottom line

Preventive care is essential to your health and well-being as it allows for early detection and intervention in many illnesses. Thankfully, federal and state laws mandate health insurance plans to cover the cost of preventive healthcare services for all their members.

North Country HealthCare is your partner in all health-related matters. Since our beginning in 1991 as the Flagstaff Community Free Clinic, our mission has been to make quality primary care accessible to all in an atmosphere of dignity and respect. We want the people in the 12 communities we serve to be healthy and thrive.

There is no time like the present to take charge of your health. Now that you know preventive services are covered by insurance, it’s time to schedule a visit! Contact us today to schedule your annual wellness exam.

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