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🩺 '''Preventive care''' refers to medical services and interventions — screenings, vaccinations, wellness visits, and early-detection tests — that [[Definition:Health insurance | health insurers]] cover with the goal of identifying or averting illness before it escalates into costly treatment. In the insurance context, preventive care is more than a clinical category; it is a [[Definition:Risk mitigation | risk mitigation]] strategy embedded in [[Definition:Benefit design | benefit design]] and often mandated by regulation, most notably the [[Definition:Affordable Care Act (ACA) | Affordable Care Act]], which requires most [[Definition:Health plan | health plans]] to cover a defined set of preventive services at no [[Definition:Cost sharing | cost sharing]] to the [[Definition:Insured | insured]].

⚙️ Carriers structure preventive benefits by referencing evidence-based guidelines — typically those issued by the U.S. Preventive Services Task Force and the Advisory Committee on Immunization Practices — and mapping them to [[Definition:Current Procedural Terminology (CPT) | CPT]] and diagnosis codes within their [[Definition:Claims processing | claims processing]] systems. When a [[Definition:Member | member]] receives a covered preventive service, the claim is adjudicated with zero [[Definition:Deductible | deductible]], [[Definition:Copayment | copayment]], or [[Definition:Coinsurance | coinsurance]] obligation. [[Definition:Insurtech | Insurtech]] platforms and [[Definition:Digital health | digital health]] integrations have expanded the delivery of preventive care through virtual wellness coaching, remote biometric monitoring, and personalized nudges that encourage members to complete recommended screenings.

📊 From an insurer's perspective, investing in preventive care lowers downstream [[Definition:Medical loss ratio (MLR) | medical loss ratios]] by catching conditions like diabetes or cardiovascular disease early, when intervention is far less expensive. [[Definition:Population health management | Population health management]] programs leverage [[Definition:Predictive analytics | predictive analytics]] to identify high-risk cohorts and proactively route them toward preventive services, bending the [[Definition:Cost curve | cost curve]] over time. Beyond financial performance, robust preventive care offerings serve as a competitive differentiator in the [[Definition:Group health insurance | group health]] market, where employers increasingly evaluate carriers on their ability to keep workforces healthy and productive.

'''Related concepts:'''
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* [[Definition:Affordable Care Act (ACA)]]
* [[Definition:Medical loss ratio (MLR)]]
* [[Definition:Benefit design]]
* [[Definition:Population health management]]
* [[Definition:Wellness program]]
* [[Definition:Cost sharing]]
{{Div col end}}

Definition:Preventive care - Revision history

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