‘Preventive’ and ‘diagnostic’ describe two types of health care you may receive. Both are ways your health care providers help you stay as healthy as possible. Understanding the difference between the two isn’t always easy, but it’s important.
Knowing the difference matters
It’s important to understand the difference between the two types of care because during the same health care visit, you may receive preventive and diagnostic services. While preventive care is provided at no cost for most members, you may be charged for the diagnostic services.
Your Kaiser Permanente benefits cover specific preventive tests at no cost for most members, usually based on recommendations from the United States Preventive Services Task Force. Other tests needed to keep you healthy might not be considered preventive and would have costs such as a deductible, a copay, or coinsurance.
What is preventive care?
Preventive care focuses on evaluating your current health, concentrates on disease prevention, and is a great way to help you stay healthy. It’s part of routine physical care such as checkups, annual wellness visits, most immunizations, and preventive screening tests. Preventive care visits are no-cost for most members.
You might hear different names for preventive care visits, including: well-care visit, well-child visit, well-adult visit, annual physical exam, and annual wellness visit.
What is diagnostic care?
Diagnostic care involves treating or investigating a health issue. It may include treatment for specific symptoms, risk factors, ongoing care, and lab or other tests needed to manage or treat a medical issue or health condition.
Here are a few ways you might get diagnostic care during a preventive care visit:
- You bring up a health concern that needs evaluation
- Your doctor catches a potential health concern during a routine visit and performs a diagnostic consultation or exam, based on their findings
- Your doctor may provide diagnostic services for an existing illness, injury, or condition
Examples of the 2 types of care
- Review of medical history and physical exam
- Review risk for certain health conditions
- Discuss how to lower current health risks
- Certain health screenings, lab tests and immunizations
No cost (for most members)2Diagnostic care
- Diagnosis or treatment for health conditions
- Lab tests and X-rays for specific conditions or illnesses
- Treatment for symptoms such as back pain or headaches
- Procedures, such as removing skin tags
Copayment, coinsurance, and deductible may apply
Knowing if your test is preventive or diagnostic
It’s also important to know that tests can be can be preventive or diagnostic. The same test may be one or the other depending on whether it’s done as part of a regular wellness visit or if it’s in response to new symptoms or existing conditions. For example:
- Preventive: A person has a routine cholesterol screening at an annual preventive care visit.
- Diagnostic: A person takes medication to treat high cholesterol. They visit their doctor to get their cholesterol level checked and make sure their medication dosage is right.
If your doctor recommends a test or treatment, feel free to as ask if there will be an added charge for that.
Sign on at kp.org/wa and go to Health Coverage to review your plan information. You can also call Member Services at 1-888-901-4636 or 206-630-4636 to go over specific covered preventive benefits, or if you have questions about your health coverage.
Please note: This article includes general guidelines and may not reflect your personal benefit plan or costs.
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