Having a regular primary care provider is essential to keeping tabs on your health. On top of managing your symptoms and recovery when you’re not feeling well, PCPs can help you prevent future health problems by identifying risk factors and suggesting lifestyle tweaks. Health insurance typically covers the cost of an annual physical. However, around 31.6 million Americans do not have health insurance. If you’re one of them, here are some tips on how to still get an annual physical without breaking the bank.
First, what is an annual physical?
Generally you can schedule two types of appointments for a yearly check-up with a primary care provider: an annual wellness visit and an annual physical exam. While these both aim to prevent health problems, functionally, they’re slightly different. Depending on your health insurance situation, they may incur different costs.
Kate Grooms, chief engagement officer at Grooms Benefit Solutions, says an annual wellness visit (also called a preventive care visit) is an assessment of a patient’s overall health. “The primary purpose is to discuss personalized prevention tactics based on medical or family history,” she says.
At a wellness visit, your provider assesses your health risk for common preventable health problems, such as heart disease, cancer and type 2 diabetes, then collaborates with you and your healthcare team to create a personalized prevention plan. The appointment offers a space to discuss any health concerns with your PCP, all with the goal of keeping you physically and mentally well.
For an annual physical exam, in addition to preventive care planning, your medical provider also physically examines your body, taking your vitals and other measurements. You typically also get some bloodwork done to make sure your body’s in tip-top shape.
How much does a physical cost?
Charges for a physical depend on a couple of factors, such as what type of physical you have and whether you have health insurance. As you might expect, visiting a doctor for anything is less expensive if you have health insurance. Grooms says insurance providers usually cover annual wellness visits at 100 percent, with no co-pay. This coverage generally includes many of the preventive screenings your doctor may suggest (e.g., blood pressure or cholesterol screenings).
If you don’t have insurance, you’ll pay the provider’s office visit fee, which Grooms says could be anywhere from $100 to $300, depending on the provider. If that’s not affordable for you, it may be worth calling around different clinics. “Many times, if you share with your provider that you will be paying yourself, they will offer you a discount on their fees,” Grooms says.
Annual physical exams are a little different. Usually, anything that happens in an exam room — for example, listening to your chest or lungs, examining your ears or checking your body mass index — is included in the cost of an office visit or co-pay. Without insurance, these visits can cost anywhere from $100 to $300; they may involve extra costs at your expense if your provider determines you should have additional testing after the exam (such as blood work to screen for diabetes or a stress test to screen for pulmonary health).
If you’re insured, you’ll likely pay a co-pay or coinsurance. If you don’t have insurance, Grooms says the best way to find the cheapest rates is to ask your provider to write down the specific work you need. Then patients can research different labs and costs online. Labs should be transparent about costs up front. For example, LabCorp and Quest Diagnostics, which are national labs that offer health screenings, offer complete metabolic panels with urinalysis for wellness for under $200.
In either case, if you’re an insured patient seeing a provider for a $0 annual exam (wellness or physical), pay attention for one more catch: If you discuss “symptoms” or managing an existing health problem, insurance no longer considers your visit a wellness exam. “It’s considered a diagnostic appointment, and co-pays and deductibles will still apply,” says Grooms.