Is a Routine Physical Covered?
Is a free physical part of coverage?
Answer
You get one free annual preventive health (wellness visit) a year. Free of course meaning no cost sharing on plans.
Keep in mind, although you get a free wellness visit, only certain services are covered. Other services you get at your visit may be subject to cost sharing amounts as laid out on your plan. To see a list of services that are covered, see our page on preventive services.
If you are confused as to what services are covered, and you are worried about incurring additional costs, make sure to let your doctor know you want the visit to be your one free annual wellness visit and to let you know if you are requesting services that go beyond what would be covered.
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Sucks. Just had my first ACA physical. Cost: $250+. Never paid this before in other medical insurance plans. .. Guess I’ve been fooled. Not the first time.
Well your routine physical should be covered for free. That is your annual check-up with no extras with a doc in your network. You should call the insurer if this was not the case so you can better understand what happened.
The annual visit is free but services during the visit may be subject to cost sharing? How can both of these things be true? This cries out for an example.
That is a great point. So in overly simple terms when you have your annual free visit you are limited to that visit type and services associated with it. If you get care beyond that, and your doctor puts the billing code in for additional services, that can result in charges.
For example, in simple terms, at your annual wellness visit you talk to your doctor about a pain in your arm and they run a test, this isn’t on our list of free preventative services (see this page for a list and resources https://obamacarefacts.com/obamacare-preventive-care/), so this part of the visit results in a charge if your doctor bills it as such.
Here is an article telling a story that might give more insight into what I mean. https://www.latimes.com/business/lazarus/la-fi-lazarus-obamacare-physicals-20160802-snap-story.html
So all this said, if you express to your doctor that you are going in for your free wellness visit and are only seeking eligible preventive services, they should let you know if the services being requested are not eligible.
As the article notes, this can feel like a sort of arbitrary division, and as people we may feel that since we are at the doctor we should be able to address all our issues. While perhaps this is the case, it is more so the case that the “free” visit is limited to specific services.