Preventive Care 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.
Understanding Preventive Care
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.
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 preventive vaccines like the flu shot
$0
For annual wellness virtual exam with an Antidote provider or in-person with an in-network provider
$0
For certain screenings like mammograms and colonoscopies
Preventive Health Services
Annual Well-Woman Visits
Annual screenings for women 40+ years old
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
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
Stay Ahead of Health Issues by Taking Advantage of Preventive Care Benefits
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.
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
Immunizations
Vaccines and Preventive Shots
Vaccine
Frequency
Coverage
Influenza Vaccine
Annual
Fully Covered
COVID-19 Vaccine
As advised
Fully Covered
Tetanus / Diphtheria
Every 10 years
Fully Covered
Shingles Vaccine
After age 50
Fully Covered
Pneumonia Vaccine
As advised
Fully Covered
Hepatitis A & B
As advised
Fully Covered
What’s Not Considered Preventive Care
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.
