Traditionally, health insurance has been viewed as something you only think about when you’re sick or injured—a safety net, not a daily resource. But in recent years, that view has been shifting. Increasingly, health plans are being designed not just to cover you in emergencies, but to keep you well in the first place.
This shift toward preventive and value-based care isn’t just good for population health—it’s changing what it means to be enrolled in a health plan. Instead of simply reimbursing medical expenses, more insurers are offering tools, services, and incentives that help you live healthier, avoid costly interventions, and get better outcomes when care is needed.
For consumers, this evolution means your health plan can—and should—function more like a partner than a policy. Here’s how to recognize a plan that delivers on that promise, and how to make the most of its features.
What Preventive and Value-Based Care Actually Means
At its core, preventive care is about addressing potential health issues before they become serious—and expensive. That might mean routine screenings, immunizations, annual checkups, or lifestyle counseling to address diet, smoking, or stress. These are the front lines of healthcare, and the earlier problems are identified, the easier and cheaper they are to treat.
Value-based care, meanwhile, focuses on outcomes rather than volume. Traditional fee-for-service models reward providers for doing more—more tests, more visits, more procedures. Value-based care flips that model by incentivizing providers to keep patients healthy and avoid unnecessary treatment. They’re rewarded for quality, not quantity.
For patients, that can translate into more personalized care, better coordination between providers, and a stronger emphasis on long-term health instead of short-term fixes.
Your Plan May Already Include Preventive Benefits—You Just Have to Use Them
One of the most underutilized aspects of many health insurance plans is free or low-cost preventive services. Most Marketplace and employer-sponsored plans are required to cover a list of preventive services with no out-of-pocket costs when provided by in-network providers. This includes things like:
Annual physical exams
Screenings for blood pressure, cholesterol, and diabetes
Certain cancer screenings (e.g., mammograms, colonoscopies)
Immunizations, including flu shots and COVID-19 boosters
Counseling for smoking cessation, obesity, and mental health
Yet millions of people skip these benefits each year—either because they don’t know they’re covered, or because they assume using their insurance always leads to a bill.
A health plan that acts like a partner will make these benefits visible, accessible, and even nudge you to use them. Look for insurers that send reminders, provide online scheduling with in-network providers, or offer wellness credits when you complete preventive screenings.
The Rise of Care Coordination and Wellness Incentives
As plans shift toward value-based models, many are beginning to assign care teams or care navigators to help you make sense of your benefits and guide you through the system. This support may be built into your plan or available through your insurer’s app or member portal.
You might also find financial incentives for participating in wellness activities, such as:
Completing a health risk assessment
Getting biometric screenings
Enrolling in tobacco cessation or weight loss programs
Using digital wellness tools or fitness trackers
These incentives may come in the form of reduced premiums, deductible credits, or gift cards. While not all health plans offer them, those that do are worth considering—especially if you’re looking for a plan that proactively supports your health goals.
What to Look for in a Value-Based Plan
Not all value-based or preventive-focused plans are created equal. Some simply check the boxes, while others genuinely aim to build long-term health relationships with members.
If you’re shopping for a plan and want one that feels more like a partner, consider looking for:
Strong primary care access and integration: Can you easily get an appointment? Do they emphasize continuity with the same provider?
Comprehensive preventive coverage: Are screenings, counseling, and vaccines included at no cost?
Mental health parity: Are behavioral health services easily accessible and covered at the same level as physical health?
Health coaching or chronic condition management: Are there resources for managing diabetes, hypertension, or other long-term conditions?
Tools and technology: Does the plan offer a good app or online portal that makes it easy to find care, compare prices, and track benefits?
Transparent pricing and proactive communication: Do they help you avoid surprise bills by clarifying costs upfront?
These features may not be listed under bold marketing claims, but they make a real difference in how your plan supports you from day to day.
How to Engage with Your Plan Like It’s a Partner
Once you have a plan that supports value-based or preventive care, the next step is using it to its full potential. That requires a shift in mindset—from “my plan is there when I need it” to “my plan is part of my health routine.”
Here are a few ways to do that:
Schedule preventive visits early in the year
Don’t wait until you’re sick. Book your annual exam or screening when your schedule is calm so you don’t put it off.
Use available apps or platforms
Insurers often partner with wellness platforms that offer nutrition tracking, meditation sessions, or telehealth access. These are often included in your plan at no extra charge.
Reach out to care coordinators
If your plan offers a member advocate or nurse line, use it. These teams can explain your benefits, help you find in-network providers, or even coordinate complex care.
Look into disease management programs
If you’ve been diagnosed with a chronic condition, your plan may offer specialized coaching, remote monitoring tools, or discounted prescriptions. These benefits can improve your quality of life while keeping costs under control.
Track incentives and maximize rewards
If your plan offers wellness points or rebates for healthy activities, track them. These programs are designed to encourage engagement—but only if you opt in and follow through.
Why This Approach Matters for Your Wallet, Too
A health plan that emphasizes prevention and value-based care isn’t just better for your long-term well-being—it can also save you money. Preventing a condition or catching it early is almost always less expensive than treating it later.
Consider the cost of a routine cholesterol screening compared to the long-term costs of unmanaged heart disease. Or the value of managing diabetes with support versus the expense of emergency complications. These savings aren’t hypothetical—they show up in your monthly costs, your out-of-pocket expenses, and even in your ability to work and enjoy life.
The same applies to mental health. Early access to counseling or therapy can prevent more severe and costly interventions later. Plans that treat mental and physical health with equal importance are better equipped to support real-life needs.
Final Thought
Your health plan shouldn’t just be there when something goes wrong. In today’s healthcare environment, the most forward-thinking plans are designed to help you stay healthy, live better, and avoid unnecessary medical expenses altogether.
That means offering preventive care without hurdles, building real partnerships between patients and providers, and using data and technology to personalize your experience.
If your current plan only shows up in your life when a bill is due, it may be time to look for something better. Because in 2025 and beyond, your health insurance should work with you—not just for you. When it does, the benefits go far beyond your deductible. They touch every part of your life.
The Bottom Line
Both HMO and PPO plans offer unique benefits, and the right choice depends on your healthcare needs, budget, and personal preferences. If you prioritize lower costs and don’t mind network restrictions, an HMO might be the best option. However, if you want greater freedom to choose providers and access specialists without referrals, a PPO could be a better fit. Carefully weigh your priorities and compare plan details to make the best decision for your health and financial well-being.
