Preventive services cost employers a fraction of what treatment costs. A preventive visit is a scheduled, coded, predictable event. A hospital admission for an unmanaged chronic condition produces a sequence of facility charges, specialist fees, pharmacy costs, and follow-up care. Prevention is an item on a fee schedule. Treatment is a series of billed events.
The national numbers make the gap visible. The United States spends about $12,900 per person per year on healthcare, roughly double what comparable countries spend. About 32% of Americans get an annual physical, and only about 8% complete the full set of recommended preventive care. About 1 in 3 skip care or prescriptions because of cost. An estimated 20-25% of healthcare spend is wasted. Employers are paying for treatment while prevention sits unused.
Prevention and treatment run on different economics
Preventive care is predictable. Employers and carriers know what a physical, screening, or vaccination costs and how often members need it. Treatment is episodic. It arrives through urgent care or the emergency room and sends costs across multiple claims, from imaging to prescriptions to follow-up visits.
- Preventive care is routine, scheduled, and priced per service.
- Treatment is episodic, urgent, and priced per event.
- Prevention produces one claim or no claim at all.
- Treatment produces a chain of claims that can stretch for months.
Under the ACA, non-grandfathered employer group health plans cover a defined set of preventive services with no member cost sharing. That coverage isn't a favor. It's a cost-containment strategy. Plans absorb the small cost of the visit to avoid the large cost of the condition later.
Why the gap persists despite the math
If prevention is cheaper, why do employers still pay so much for treatment? In a fee-for-service model, hospitals and specialists bill for what they do, and doing more costs more. A prevented heart attack has no claim attached to it. A treated heart attack does.
How employers close the gap
Employers close the gap by making prevention the easiest and most financially rewarding action in the plan. That means $0-co-pay preventive care, instant reward dollars for verified preventive actions, and automatic retirement contributions tied to healthy behavior. When employees use prevention first, fewer claims hit the primary plan. The employer sees fewer claims and lower costs over time.
WellthCare™ works alongside your existing health plan and gets used first. Employees get $0-co-pay care, earn reward dollars at the WellthCare Store™, and build retirement savings automatically through verified preventive actions. For the employer, the comparison between prevention and treatment stops being theoretical. The plan design changes the incentive: verified prevention earns, and treatment costs show up in claims.
See what a WellthCare Plan would look like for your team.
This article is for general information only and is not legal, tax, or medical advice. Employers should consult their own advisors.