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Understanding the cost differences for preventive vs. diagnostic care
Understanding how much you'll pay for care can help you choose the right coverage and budget for your health needs. But what happens if you’re not sure how much your visit to the doctor will cost? Or if you get a bill for a visit you thought your plan covered at no extra cost to you?
To avoid financial surprises, it helps to understand the difference between preventive and diagnostic care — and the costs associated with each.
What is preventive care?
Preventive care helps keep you healthy by preventing or detecting illnesses before they progress and become more difficult to treat. It also protects you by detecting diseases before you have symptoms.
What are some examples of preventive services?
Examples of preventive services include:
- Flu shots and COVID-19 vaccines
- Colon cancer screenings or mammograms
- Routine physical exams (with no symptoms)
- Routine screenings for blood pressure or cholesterol
- Pediatric well visits
What is diagnostic care?
When you have a health concern, any care or service used to diagnose or treat that concern is diagnostic care. For example, if your leg hurts after an accident, your doctor may recommend diagnosing the issue with a test like an X-ray. Based on the results, your doctor may also suggest treatment like pain medication or physical therapy.
Some examples of diagnostic care include:
- Diagnostic imaging like X-rays and ultrasounds to confirm injury or illness
- Certain blood tests to determine or manage conditions
- Sexually transmitted infection (STI) testing when there are symptoms
- Managing ongoing conditions like diabetes and cancer
- Discussing new symptoms with your doctor
- Casting and splinting broken bones
What is the cost of preventive care vs. diagnostic care?
What you end up paying for a visit depends on whether you get preventive or diagnostic care.
Preventive care
- Example: You’re an adult with high blood pressure and you get a diabetes screening.
- Cost: No out-of-pocket cost if covered by your plan.
Diagnostic care
- Example: Your doctor finds a mole and removes it for testing.
- Cost: You may owe a copay, coinsurance, or deductible.
To find out how much you’ll owe for a service, you can use our cost estimate tool.
Or you can refer to your benefit summary for your plan’s full list of preventive and diagnostic care coverage.
When does preventive care lead to diagnostic care?
Preventive care helps you stay healthy before you have symptoms. But when you have symptoms, you may need diagnostic care to evaluate or treat them. For diagnostic care, you’ll need to pay a copay, coinsurance, or deductible — even if it’s during an office visit for preventive care.
| Examples of preventive care | Examples of diagnostic care |
|---|---|
| Routine physical exam when you’re feeling well and don’t have symptoms | When you talk with your doctor about new or existing health issues, concerns, or symptoms during your routine physical exam or other appointment |
| Routine lab tests to check your blood sugar and cholesterol levels |
Lab tests for a specific condition, based on your symptoms |
| Mammogram when there are no symptoms and no previous breast disease diagnosis |
Mammogram after a suspicious test result or signs of possible breast disease |
Colon cancer screening when you have:
|
Colon diagnostic testing when you have a known symptom like chronic diarrhea, stomach pain, or blood in your stools |
Why preventive care is important
Your best line of defense against illness is to stay on top of your preventive care. Whether it’s getting your flu shot each year or going in for routine screenings, preventive care is a necessary part of staying healthy. At Kaiser Permanente, we focus on helping you live a healthier life through preventive care. That’s why most of our plans cover many routine preventive services at $0 copay.
Learn more about preventive care.
To check whether your latest exam or test is a preventive service, see our list of preventive services. And if you get a bill that you may have trouble paying, call Member Services to see if financial help is available.