What is preventive care and why it’s important
We all know how important it is to have a primary care provider (PCP) and get regular preventive exams. It’s even been proven that regular preventive care leads to better health outcomes in the long run.
But what is preventive care? And what should your benefits cover? It’s important to feel informed and empowered when you go into your next preventive exam, sometimes referred to as an annual wellness exam, to avoid unexpected costs down the road.
What is preventive care?
Preventive care is the medical care you receive to help prevent disease before it happens. It can include age-appropriate screenings, vaccinations, lifestyle changes and early disease intervention. It can also provide support to prevent future health issues or behavioral conditions. Meeting with your primary care provider for your annual wellness exam can decrease the likelihood of disease or catch illnesses in their early stages.
Depending on your age, gender, lifestyle and genetics, you may be at higher risk for certain conditions and diseases.
Personalized care starts with the right provider
Preventive care works best when you have a provider who knows you. A primary care provider can help personalize your care, answer questions and keep your health on track year after year. Use myWellmark® to choose a PCP and take an active role in your care.
Preventive care for men
Some conditions and illnesses are more common in men, such as:
- Parkinson’s disease
- Kidney stones
- Melanoma (after age 65)
Men should see their primary care provider every year for their annual wellness exam to discuss their family history and risk factors for certain illnesses. In 2025, men died by suicide at a rate nearly four times higher than women, so it’s important that they talk to their primary care provider about any mental health concerns. It’s also a good idea to discuss lifestyle habits, including diet and exercise.
Preventive care for women
Women are especially at risk for certain illnesses and types of conditions as they age such as:
- Alzheimer’s Disease
- Osteoporosis
- Gallstones
Beyond meeting with their primary care provider to discuss everything from mental health concerns, diet and exercise habits and lifestyle choices, women should also visit a gynecologist (OB/GYN) at least once a year for a pelvic exam. It’s important that women have routine pap smears starting in their early 20s and examine themselves for breast cancer on a regular basis. Beginning at age 40, it is recommended women have a mammogram every other year.These visits are also a good time for women to talk with their doctor about plans for children and if contraceptives may be right for them.
Preventive care for children and adolescents
It's especially important for children and adolescents to visit their primary care provider at least once a year, or more frequently depending on age, to stay up to date on their immunizations and track their developmental milestones. Your child’s doctor may also ask about your child’s:
- Sleeping patterns
- Diet and exercise
- Behavior
- Mental health, including mood and signs of anxiety or depression
- Daily habits, such as teeth brushing and screen time
- School and other extracurricular activities
Making your child’s preventive care a priority sets them up for success in the future. Creating healthy habits with your child early in life and teaching the importance of preventive care can lead to a healthier adult life.
Before your visit, check your benefits to understand what will and won’t be covered at your checkup. Wellmark has outlined a list of common preventive services that are covered under the Affordable Care Act (ACA). No matter what your specific plan covers, these are great preventive health screenings to keep in mind and discuss with your provider:
- Annual wellness examination
- Colorectal cancer screening
- Depression screening
- High blood pressure screening
- Immunizations such as the flu shot
Any care you receive beyond your annual wellness exam or well-woman visit to the OB/GYN is not considered preventive. This can include visits to specialists, diagnostic tests and visits to your primary care provider when you’re sick or injured.
In some cases, a preventive exam can turn into a medical visit, which could lead to unexpected out-of-pocket costs.
Sometimes, there is confusion about the difference between preventive care and diagnostic or medical care. If your health care provider discovers something during your exam, they may order additional testing. If this results in a diagnosis other than preventive care, the appointment could be billed as a medical visit where cost-share may apply. This may lead to out-of-pocket costs that you weren't expecting.
For example, let's say you went to your annual preventive exam. You and your health care provider talked about your personal and family health history, completed a physical exam and any immunizations you weren't up to date on, and did necessary bloodwork. At the same time, you talked to your health care provider about some knee pain you've been experiencing. Because of this conversation, another exam or procedure might be necessary, leading to a potential cost for you. Remember, you can always talk to your health care provider or Wellmark if you are concerned about unexpected costs to find a solution that works for you. In the end, your health is the most important thing to prioritize.
Some preventive services have age or frequency guidelines. These guidelines are based on national health recommendations and may vary by service.
To see what applies to you, review your benefits in myWellmark or talk with your primary care provider.
Why is preventive care important?
Preventive care is important because it can catch illness in its early stages while it may be easier and less costly to treat. Knowing your family history and seeing your primary care provider for your annual wellness exam can help prevent illness. Most health plans will cover the entire cost of preventive care, so you’ll likely pay nothing for your visit as long as you stay in-network.
Avoid surprises during preventive care visits
Make sure you know the basics of your health plan and how it works. Don’t leave it up to your provider to know the ins and outs.
If you are a Wellmark member, you can check your coverage when you log in to myWellmark. If you still have questions, you can reach out to Wellmark Customer Service at 800-524-9242 (TTY: 888-781-4262), Monday through Friday from 7:30 a.m. to 5:00 p.m. (Central Time).