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Preventive Care

Preventive Care Can Help Protect Your Future

Stay ahead of health issues by taking advantage of your preventive care benefits. You can help detect or prevent serious health issues before they become major health issues.

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What is preventive care?

Preventive care refers to the routine health services that help individuals stay healthy and avoid illness, disease, or other health problems before they start. This includes regular check-ups, screenings, immunizations, and counseling to detect potential health issues early when they are most treatable. By focusing on prevention, individuals can reduce the risk of chronic conditions, improve long-term health outcomes, and lower healthcare costs. Preventive care is a vital part of maintaining overall well-being.

Why is preventive care important?

Evidence-based screenings can detect diseases earlier, potentially saving your life. With 7 in 10 deaths annually attributed to preventable chronic diseases, taking action matters.* Members enjoy 100% coverage for recommended preventive services under their plan.**

What does preventive care cost?

Antidote Health plans include essential screenings, vaccinations, and wellness visits with in-network providers—all at no extra cost.** It’s actually a requirement for Affordable Care Act (ACA) health plans to include 100% coverage for preventive care. Antidote members can look forward to:

  • $0 for your annual wellness exam
    Virtual with an Antidote provider or in-person with an in-network provider

  • $0 for preventive vaccines, like the flu shot

  • $0 for certain screenings like mammograms and colonoscopies

  • Age-Based Preventive Screenings

    Ages 18–39

    Blood pressure monitoring, depression screening, and STI testing annually

    Ages 40–64

    Cholesterol checks, diabetes screening, colorectal cancer screenings are essential

    Ages 65+

    Fall risk assessments, bone density tests, and vision/hearing evaluations

  • Child and Adolescent Preventive Care

    Infant Wellness (0-1 year)

    7 visits in the first year to monitor development, provide immunizations, and support parents

    Child Development (2-12 years)

    Annual check-ups including developmental assessments, vision and hearing screenings, and recommended immunizations

    Adolescent Care (13-21 years)

    Screenings addressing physical, emotional, and behavioral health needs during key growth years.

  • Women's Preventive Health Services

    Annual Well-Woman Visits

    Comprehensive assessments tailored to your health history and needs

    Mammogram Coverage

    Annual screenings for women 40+ years old

    Cervical Cancer Screening

    Tests every 3–5 years based on your age and risk factors

    Comprehensive Prenatal Care

    14+ covered services for expecting mothers

  • Men's Preventive Health Services

    Prostate Cancer Screening

    Covered annually for men 50+ (45+ with risk factors) to detect common cancer early

    Abdominal Aortic Screening

    One-time screening for aneurysms in men 65–75 with smoking history

    Testicular Examinations

    Part of your annual check-up to detect issues early when treatment is most effective

    Mental Health Screening

    Specialized tools designed for men's specific mental health needs and concerns

Immunizations
Vaccines and preventive shots

Vaccine
Frequency
Coverage
Influenza Vaccine
Annual
Fully Covered
COVID-19 Vaccine
As recommended
Fully Covered
Tetanus / Diphtheria
Every 10 years
Fully Covered
Shingles Vaccine
After age 50
Fully Covered
Pneumonia Vaccine
As recommended
Fully Covered
Hepatitis A & B
As recommended
Fully Covered

What’s Not Considered Preventive Care

Understanding the difference between preventive care and other medical services helps you know what to expect from your coverage.

  • Treatment Services

    Medical care to treat existing health problems

    • Procedures to remove abnormal tissue

    • Treatment for diagnosed conditions

    • Therapeutic interventions

    • Surgery and invasive procedures

  • Diagnostic Services

    Tests ordered to diagnose or monitor existing conditions

    • Follow-up tests for abnormal results

    • Monitoring tests for chronic conditions

    • Diagnostic imaging for symptoms

    • Laboratory tests to confirm diagnosis

  • Elective Screenings

    Tests not recommended by medical guidelines

    • Screenings more frequent than recommended

    • Tests for asymptomatic low-risk individuals

    • Experimental or unproven screening methods

    • Screenings outside age recommendations

  • Cosmetic Services

    Services primarily for appearance enhancement

    • Cosmetic dermatology procedures

    • Elective plastic surgery

    • Non-medical aesthetic treatments

    • Appearance-focused interventions

Important Distinctions

  • When Prevention Becomes Treatment

    If a preventive screening finds an abnormality, any follow-up care, additional tests, or procedures to address that finding are considered treatment, not prevention, and may be subject to your plan's deductible and copays.

  • Frequency Guidelines Matter

    Preventive services are only covered at the frequency recommended by medical guidelines (like USPSTF). Getting screenings more often than recommended typically requires cost-sharing.

  • Symptom-Based Care

    If you have symptoms or a known condition, related medical care is considered diagnostic or treatment, not preventive, even if it involves the same type of test or exam.

  • Provider Network Requirements

    Even covered preventive services may require cost-sharing if you visit an out-of-network provider. Always use in-network providers for full preventive coverage.

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