Is an Annual Physical Exam Covered By Insurance?

on October 23rd, 2023
with 0 Comments
in Health Information and Tips

Although all signs indicate you’re well, a health condition might grow in your body without your knowledge. However, a scheduled annual physical exam can detect a developing illness before it becomes full-blown.

A health provider performs a physical exam to generate a preview of your overall health. The examination focuses on preventive care so you can maintain good health. If your provider suspects you have a health condition, they may refer you to a specialist or perform further tests to learn more about it.

If you like being in control of your health, consider scheduling an annual physical exam. More importantly, consider doing an annual physical exam from a trusted urgent care center for better health outcomes.

Is Annual Physical Exam Covered By Insurance?

Most insurers cover an annual physical exam done once a year without copay. However, the coverage may exclude associated costs such as lab analysis. In other instances, the insurer may require you to pay a portion of specific recommended tests and services.

In addition, the insurance company doesn’t classify the visit as a physical exam if new symptoms appear. It is also not the case when you discuss an ongoing problem with a healthcare provider.

It is no longer a physical exam but a sick or chronic condition visit where copay or coinsurance applies.

How Much Does an Annual Physical Exam Cost Without Insurance?

If you don’t have insurance, the average cost of a physical exam ranges from $50-$200. The range depends on your age and any underlying medical conditions.

You can get a physical exam with the help of a primary care physician(PCP), nurse practitioner(NP), or physician assistant. Records suggest that seeing a primary care physician is slightly more expensive than taking the exam from a physician assistant or nurse practitioner.

Consider weighing your options and looking at your budget before making an appointment.

When a Physical Exam Visit Attracts a Bill?

Your insurance plan offers 100% coverage when you see a doctor in the plan network. The insurance plan caters to a physical exam, which reviews your overall health, identifies risks, and establishes ways to stay healthy.

However, if the purpose of the visit is to get treated for a specific health concern or condition, you may have to pay for the visit as part of your deductible, copay, or coinsurance.

What Can I Discuss With My Doctor During a Physical Exam Without Being Charged?

  • Current health condition
  • Your family health history
  • Ways of maintaining a healthy lifestyle
  • Past health conditions and surgeries
  • Risks of a specific health condition

Why Do You Need a Physical Exam?

Here are a few reasons for performing a physical exam:

  • Check your overall health
  • Engage the healthcare provider about your health
  • Verify that you’re in good physical and mental health to work in a job that requires pre-employment physicals or participate in a sport that requires a physical exam.
  • Get vaccines or immunizations.
  • Check whether you have underlying medical conditions and address any symptoms you may have

What Does a Physical Exam Entail?

Is an Annual Physical Exam Covered By Insurance?

A standard physical exam may include the following:

Vital Sign Checks

A vital signs check-up involves taking the blood pressure reading, evaluating the respiratory rate, and checking your heart rate. Consider attending a vital sign check-up once every year or three years, depending on your health history.

Updating the Health History

The physician may request an update on new developments and changes in your health history. The health history session includes questions about their job, relationships, allergies, medications, supplements, and recent surgeries.

Visual Exam

The doctor will assess your appearance for signs of a potential health problem. They will then check specific body parts that could indicate an existing health issue. The visual examination consists of a look into the head, eyes, chest, abdomen, hands, wrists, speech, and walking.

Physical Exam

During the physical exam, the healthcare provider will use a tool to look into the eyes, nose, ears, and throat. They may also listen to the performance of your heart and lungs.

The physical exam also includes:

  • Checking skin, nails, and hair
  • Touching specific body parts like the abdomen to feel abnormalities
  • Testing reflexes and motor function
  • They may also examine your genitals or rectum

Laboratory Tests

The doctor may draw blood to perform a few laboratory tests as part of your physical exam. The laboratory test could be a complete blood count or a chemistry panel. The chemistry panel tests the blood plasma and may provide information about your kidneys, blood chemistry, liver, and immune system.

If a doctor identifies irregularities in the body, it might indicate a more significant problem. The doctor may also request a diabetes screen and a thyroid screen. A healthcare provider may ask for a cholesterol test if you’re at an increased risk of heart attack, stroke, or heart disease.

Screening Test Performed At a Physical Exam

Here are a few tests you can expect from a doctor’s office, which vary depending on your gender:


Women with a low to average risk of developing breast cancer— mostly aged 50-74- are advised to perform a mammogram every two years. However, depending on your medical or family history of breast cancer, you may need early or frequent testing.

Cholesterol Test

Healthcare providers advise men to perform a regular cholesterol test at the age of 35 years. On the other hand, women should perform frequent cholesterol tests at 45 years and above. Even so, you may need a cholesterol test as early as 20 years if you’re genetically predisposed to diabetes or heart disease.

Pap Smear

A healthcare provider may request a pap smear to screen for cervical cancer. Women are encouraged to undergo cervical cancer screening at the age of 21. After that, women are encouraged to undertake the screening every three years as long as they have a healthy immune system.

Once a woman is 30 years old, they are encouraged to do a pap smear every five years until age 65. After 65 years, most women no longer need a pap smear.

Pelvic Exam

A physician can perform a pelvic exam with or without a pap smear test. A pelvic exam involves examining the vagina, vulva, and cervix for signs of sexually transmitted infection(STI) or any other condition.

Prostate Cancer Screening

Men who are 50 years and above are encouraged to undergo prostate cancer screening. However, those with a family history of prostate cancer are encouraged to take the test as early as 40 years old.

Diabetes Screening

You should consider screening for diabetes if you have a family history or are at risk of diabetes. Factors that display a high risk of diabetes include being overweight and having high blood pressure or cholesterol levels.

STI Screening

A healthcare provider may suggest STI screening for a person at risk of getting an STD. For instance, men who engage in sex with other men are at a high risk of contracting sexually transmitted infections.

Similarly, all pregnant women must screen for hepatitis B, HIV, syphilis, and chlamydia in early pregnancy. A healthcare provider can screen for an STI infection using a blood test, urine sample, or fluid sample.

Mental Health Screening

Mental health screening involves a set of questions administered by a healthcare provider that checks for signs of a mental disorder. The questions evaluate a person’s mood, behavior, thinking, and memory.

Mental health screening helps detect a mental disorder at an early stage. If the screening detects signs of a mental illness, there’s a need for further testing to establish a specific mental disease.

A mental health screening determines whether a person has:

  • A risk of developing a mental illness
  • Needs further testing to diagnose or rule out a mental health disorder
  • Requires immediate medical care even before completion of diagnostic tests

Here’s what happens during a mental health screening.

The healthcare provider will request you to answer questions about your mood, feelings, appetite, sleep, and other aspects of your life. The healthcare provider may ask you the questions directly or request you complete a questionnaire.

Then, you’ll have a face-to-face session with the mental health provider to discuss the answers.

Provide complete and honest answers for the best results. If a primary care provider is doing the assessment, they may conduct a physical exam and blood test. Although no medical test specifically diagnoses a mental disorder, a blood test can detect whether a specific condition, such as thyroid disease or electrolyte imbalance, has triggered a mental illness.

What Can I Expect During a Physical Exam?

During the physical exam, the healthcare provider will ask you how you’re feeling and if you have any health condition symptoms. They will also request you to share any concerns you might be having about your health.

If you’re performing the physical exam for a specific purpose, e.g., sports physical or pre-employment check, tell the healthcare provider so they can fill out the paperwork.

Here are a few examinations you can expect before the interactive session.

A member of the care team will perform the following test in advance:

  • Measure your height and weight
  • Take records of your vital signs
  • Conduct a preliminary review of your family medical history and medical history
  • Establish over-the-counter medications, prescriptions, and supplements that you’re currently taking
  • Review all health concerns and symptoms

The healthcare provider may ask questions to understand your symptoms and health concerns.

Here is a sample of the questions:

  • Are you feeling any unusual discomfort?
  • Where is the discomfort or the pain located?
  • Can you assign a number to the pain, with 1 being mild and 10 being the most severe pain
  • What does your pain feel like— dull, achy, pressured, or sharp?
  • What remedy relieves your discomfort? Is it adjusting your position, medication, or rest?
  • Do you associate any activity with your pain or discomfort? Is it after eating, at night, or after an intense activity?

How to Prepare for a Physical Exam

You don’t have to prepare for a physical exam unless your doctor requires you to avoid certain meals.

Even so, take note of the following before going for a physical exam:

  • List down anything you’re allergic to
  • Note down all your current medications
  • Carry your recent lab records
  • Carry or list down any assistive devices, such as a pacemaker
  • List down the symptoms of a health issue you may have noted
  • Write down the contact details of healthcare providers and specialists that you’re currently seeing

Be prepared to answer the following questions from a doctor:

  • What is your diet?
  • How good are your sleeping patterns?
  • Are you experiencing any abdominal pain or discomfort?
  • Do you use drugs, smoke, or drink alcohol?
  • How often do you exercise?

Similarly, prepare to ask the healthcare provider a few questions, including:

  • Do I need any vaccination?
  • Are there any other additional screening tests for my age and health status?
  • What lifestyle or routine changes can I make to improve my health?
  • Is there anything in my family history that puts me at risk of a health condition?

Physical Exam Results and Follow-up

A physical exam provides a preview of your overall exam. After the healthcare provider has completed the exam, they will let you know if:

  • You require further tests
  • You have health concerns that you should know about
  • You need to see a specialist
  • Whether there are any steps you can take to improve your health
  • You are in good health

If the healthcare provider finds out something that affects your health, they may request you to come sooner than one year for tests.

Stay In Charge of Your Health With a Physical Exam

Do medical conditions come as a surprise? Maybe not.

It’s probably a result of ignoring the mild signs you’ve been having for a while. Fortunately, you can take control of your health by adhering to an annual physical exam. A physical exam can predict an upcoming health issue and address any concerns.

That said, consider doing your annual physical from a reputable health facility like Newport Urgent Care Center for a comprehensive health review.

Contact us online or call us at 949.752.6300 to book an appointment.