Preventive or diagnostic care: Know the difference

Some doctor visits are fully covered. Others may come with out-of-pocket costs. The difference often depends on whether your visit is preventive or diagnostic.
Here’s a simple way to tell:

• Do you feel well and are going for a routine checkup? That’s preventive care.
• Do you have symptoms or a concern you want checked? That’s diagnostic care.

What is preventive care?

Preventive care helps keep you healthy and catch problems early — before symptoms appear.

This includes routine checkups, screenings and tests designed to prevent illness or detect issues early. Many preventive services are covered as part of your plan.

What is diagnostic care?

Diagnostic care focuses on finding or treating a problem.

This includes visits to evaluate symptoms, monitor ongoing conditions or follow up on test results outside the normal range. It also includes routine care for chronic conditions.

How do the differences affect my coverage?

Your coverage may change depending on the type of care you receive.

• Preventive services are often covered at no cost to you.
• Diagnostic care may include out-of-pocket costs, such as copayments, deductibles or coinsurance.
• If diagnostic care happens during a preventive visit, you may still have some costs.

That’s why it helps to ask questions during your visit. If your doctor recommends a test, ask why — the purpose of the test can affect how it’s covered.

Here are a few examples of common services and when they may be considered preventive or diagnostic:

Why preventive care matters

Preventive care helps you stay ahead of potential health issues — so you can take action early and stay on track.

Learn more

Health Alliance Plan members can review their coverage details by logging in at hap.org.

This information is a general guide and does not replace advice from your doctor. Always talk with your doctor about the care that’s right for you.