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Discover if your insurance covers your physical!
Find out if your insurance plan covers your annual physical. Certain criteria may apply, including age and pre-existing conditions.
Factors such as your insurance plan, age, health status, and gender can influence your coverage. Don’t miss out on vital preventive care – know what your insurance includes!
If you are not sure whether or not a physical is covered by insurance, you can contact your insurance company or your doctor’s office.
They will be able to tell you exactly what your coverage includes.
But first, do you need free expert help navigating your health insurance? Contact to get help finding affordable coverage for your needs.
What a Physical Exam Does
A physical exam is a routine medical test that is performed by a doctor or other healthcare provider. It is a way for the provider to assess your overall health and to look for any signs of disease.
The purpose of a physical exam is to:
Check your general health
The doctor will look at your weight, height, blood pressure, and other vital signs. They will also listen to your heart and lungs and check your reflexes.
Look for any underlying conditions
The doctor will ask you about your medical history and family history. They will also examine you for any signs of disease, such as lumps, bumps, or abnormal skin changes.
Identify any health risks
The doctor will talk to you about your lifestyle and risk factors for diseases such as heart disease, stroke, and cancer. They may also recommend screenings or tests to help you stay healthy.
The types of tests included in a physical exam vary depending on your age, health history, and risk factors. However, some common tests include:
Vital signs:
This includes your weight, height, blood pressure, heart rate, and respiratory rate.
Blood tests:
This includes a complete blood count (CBC), which measures the number of different types of blood cells in your body.
Urine tests:
This includes a urinalysis, which checks for signs of infection or other problems.
Physical examination:
This includes the doctor looking at your body, listening to your heart and lungs, and checking your reflexes.
If you have any concerns about your health, be sure to talk to your doctor. They can help you understand the purpose of a physical exam and what tests may be included.
Who Should Get Regular Physicals, and Why Is It Important?
Everyone should get regular physicals, regardless of age or health status. However, there are certain people who are at a higher risk for certain health conditions and may need to get physicals more often.
These include:
Adults over the age of 40
As people age, they are more likely to develop chronic health conditions such as heart disease, stroke, and cancer. Regular physicals can help to identify these conditions early on, when they are most treatable.
People with a family history of chronic health conditions
If you have a family history of certain health conditions, you are more likely to develop them yourself. Regular physicals can help to identify these conditions early on and can also help you to develop a plan to manage your risk.
People with chronic health conditions
If you have a chronic health condition, such as diabetes, high blood pressure, or heart disease, it is important to get regular physicals to monitor your condition and make sure that it is being managed properly.
Women who are pregnant or planning to become pregnant
Regular physicals during pregnancy can help to ensure that both the mother and the baby are healthy.
People who are overweight or obese
Overweight and obesity are major risk factors for many chronic health conditions. Regular physicals can help you to assess your risk and develop a plan to lose weight and improve your health.
People who smoke or use tobacco products
Smoking is a major risk factor for many chronic health conditions, including heart disease, stroke, and cancer. Regular physicals can help you to assess your risk and develop a plan to quit smoking.
Regular physicals are important because they can help to identify health problems early on, when they are most treatable. They can also help to prevent health problems by encouraging healthy behaviors such as exercise, a healthy diet, and smoking cessation.
If you have not had a physical in the past year, or if you have any concerns about your health, talk to your doctor about scheduling a physical exam.
Insurance Coverage for Physicals
The amount of insurance coverage for physicals varies depending on the type of insurance plan you have. Most health insurance plans cover annual physicals, but some may require you to meet certain criteria, such as being a certain age or having no pre-existing conditions.
Here is a breakdown of what different types of insurance plans typically cover for physicals:
HMO plans:
HMO plans typically cover annual physicals for all members. However, you may need to see your primary care doctor to get a referral for the physical.
PPO plans:
PPO plans typically cover annual physicals for all members, but you may have to pay a copay or coinsurance. You can see any doctor who is in your plan’s network for your physical, but you may have to pay more if you see a doctor who is not in your network.
POS plans:
POS plans typically cover annual physicals for all members, but you may have to pay a copay or coinsurance. You can see any doctor for your physical, but you may have to pay more if you see a doctor who is not in your plan’s network.
Medicare:
Medicare covers annual wellness visits for all members who have had part B longer than 12 months. While these visits are not considered physical exams, they include blood pressure check, medical and family history review, prescription review, and health advice based on the member’s needs.
Medicaid:
Medicaid coverage for physicals varies from state to state. However, most states cover annual physicals for all members.
If you are not sure whether or not a physical is covered by insurance, you can contact your insurance company or your doctor’s office. They will be able to tell you exactly what your coverage includes.
Cost-Saving Tips When Getting a Physical Covered by Insurance
Here are some cost-saving tips when getting a physical covered by insurance:
Check with your insurance company:
Before you schedule your physical, check with your insurance company to see what is covered and what your out-of-pocket costs will be. This will help you avoid any surprises when you receive your bill.
See a doctor in your network:
If you have a health insurance plan with a network of doctors, see a doctor who is in your network. This will help you save money on your out-of-pocket costs.
Ask about preventive care benefits:
Many health insurance plans offer preventive care benefits, which means that certain preventive services are covered at no cost to you. A physical exam is typically considered a preventive service, so you may be able to get your physical for free.
Consider getting a discount card:
There are a number of discount cards available that can help you save money on medical services. These cards typically offer discounts on things like doctor’s visits, prescription drugs, and lab tests.
Ask about payment options:
Many doctors’ offices offer payment plans or discounts for paying in full. If you are struggling to pay for your physical, ask your doctor’s office about their payment options.
Here are some additional tips:
Bring your insurance card and a copy of your insurance plan to your appointment.
This will help the doctor’s office verify your coverage and ensure that you are charged the correct amount.
Ask the doctor’s office about any copays or coinsurance that you may owe.
This will help you budget for your out-of-pocket costs.
Be aware of any additional tests or services that may be recommended during your physical.
These tests or services may not be covered by your insurance, so you will need to be prepared to pay for them out of pocket.
Ways to Find a Doctor Who Will Take Your Insurance for Physicals
Here are some ways to find a doctor who will take your insurance for physicals:
Use your insurance company’s website:
- Most insurance companies have a website where you can search for doctors who are in their network. This is a good way to find doctors who are likely to accept your insurance.
Call your insurance company:
- You can also call your insurance company and ask them for a list of doctors who are in their network. They will be able to give you a list of doctors in your area who accept your insurance.
Use a doctor search engine:
- There are a number of doctor search engines available online. These engines allow you to search for doctors by location, specialty, and insurance. This is a good way to find doctors who are in your area and who accept your insurance.
Ask your friends or family:
- If you know someone who has a doctor who they like, ask them if their doctor accepts your insurance. This is a good way to get a personal recommendation for a doctor.
Here are some additional tips for finding a doctor who will take your insurance for physicals:
Be sure to ask about your out-of-pocket costs:
- Even if a doctor is in your insurance network, you may still have to pay some out-of-pocket costs for your physical. Be sure to ask the doctor’s office about their fees before you schedule your appointment.
Consider seeing a doctor who is a patient-centered medical home:
- Patient-centered medical homes (PCMHs) are designed to provide comprehensive, coordinated care to patients. PCMHs typically have a team of doctors, nurses, and other healthcare providers who work together to care for patients. This can be a good option if you are looking for a doctor who will take the time to listen to your concerns and develop a plan for your health.
Many insurance plans do cover regular physicals as part of their preventive care services.
However, it is important to review your insurance policy or contact your insurance provider to understand the extent of coverage, any copayments or coinsurance requirements, and any age or risk factor limitations that may apply.
Regular physical exams are valuable for maintaining overall health and identifying potential medical conditions, so it is worth exploring the coverage options provided by your insurance plan to prioritize proactive healthcare.
Get your questions answered with Apollo Insurance Group by calling (913) 279-0077. Calling this number will connect you to a licensed insurance sales agent.
Frequently Asked Questions: Are Physicals Covered By Insurance?
Are annual physicals covered by insurance?
In most cases, yes! Under the Affordable Care Act (ACA), most health insurance plans are required to cover preventive care services, which includes annual physical exams [eHealth Insurance, What’s Preventive Care and Is it Covered by Insurance?]. This means you likely won’t have to pay a copay, coinsurance, or deductible for the visit itself, as long as you see a doctor within your insurance network
Are there any exceptions?
There are a couple of things to keep in mind:
- If your physical exam turns into a treatment visit to address a specific health concern, you might have to pay some costs depending on your plan [Newport Urgent Care, Is Annual Physical Exam Covered By Insurance? What To Know].
- Some preventive care services, like certain lab tests, might have a separate cost depending on your plan [South Shore Health, What Insurance Covers During Physicals].
How can I be sure what's covered?
It’s always best to check with your doctor and insurance provider to confirm what preventive care services are covered under your specific plan, and any potential out-of-pocket costs for recommended tests [Blue Shield of California, Understanding Your Preventive Care Benefits].
Sources:
- The Centers for Medicare & Medicaid Services (CMS): https://www.cms.gov/
- The National Institute of Health (NIH): https://www.nih.gov/
- The American Academy of Family Physicians (AAFP): https://www.aafp.org/
- The Centers for Disease Control and Prevention (CDC): https://www.cdc.gov/
- Healthcare.gov: https://www.healthcare.gov/
- Medicare.gov: https://www.medicare.gov/coverage/yearly-wellness-visits
I am a professional content writer specializing in the health insurance field. My work primarily focuses on simplifying the complexities of healthcare coverage, aiming to provide clarity and insight into an often confusing subject. Empowering people to make informed decisions about their well-being is my passion. At Apollo Health Insurance, we share that commitment. Apollo Health Insurance stands at the forefront of securing the best healthcare coverage for individuals, ensuring affordability without compromising on quality.