Exactly what is and is not covered or to be discussed during a routine physical so as not to trigger additional charges?


The free preventive visit under ObamaCare covers routine wellness and prevention, it may not cover discussion of existing conditions and other asides. You can see a full list of all preventive screenings and immunizations here, but we haven't been able to find a "full list" of everything considered preventive /wellness and everything considered "other".

Basically it works like this, your doctor has one annual visit to catch things before they become a problem. That may be helping you to book immunizations, it may be discussing diet, it may be basic check-up stuff, it may be setting up a cancer screening. All of this prevention, along with the basic checkup stuff, is coded as an "annual wellness visit".

If your doctor finds that you have an ear infection while checking your ears, they probably won't charge... but technically they could as you would have known you had an ear infection. Therefore treating the preexisting condition isn't preventive it is a treatment. How does your doctor code? This is up to your doctor. Do they let something slide, do they consider it preventive, or do they put their foot down as they have a lot of preventive visits to do today and each takes time.

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Tim McMullen on

I, understand that if you bring up a problem, or have lab tests, you will be charged. You, will have to pay for labs, exrays ect. I feel, you might as well pay, your co-pay like I plan to. I, am not going to make an appointment for another day, afraid to ask a question. Obama are is stupid, if you can’t ask about, lets say, your thyroid or high blood pressure. I, have a Medicare suppement, and get extra help, yet I still pay a 35.00 co-pay, and am sure it will go up in 2017!!

Vicki Royer on

It may. it may. it may. it may,,,, but WHAT specifically DOES it cover? What specifically DOES it include? Seriously … the Bill was 3000 or 6000 pages long. How can it be so vague as the response above??????? My rating of this answer below IS a big fat 0.

Erin on

You can see a full list of the preventative care that is covered under the Affordable Care Act, but as the answer noted, it largely depends on your provider using the correct billing codes for those procedures. There are also other criteria (like age, gender, and health history)for many of those preventative care services in order for them to be covered as necessary preventative care. The best way to ensure that a preventative measure will be covered before deductible is to call your insurance provider and ask them what billing codes and criteria they need the provider to use in order for it to be billed as a preventative service. Then provide that information to your doctor.

Deb Kusant on

it’s July 2019 – is this still in effect for one annual physical and gynological exam a year with one free mammo a year?
If so aren’t ALL plans/organizations covered by this law?
HBCBS – under a Union Local 464?
Please advise.

ObamaCareFacts.com on

All plans do have this requirement aside from grandfathered plans. I think in some cases Union plans were able to skirt the requirements this to keep costs down (as were large employers)… although I think the reason was because most already offered these sorts of benefits (although we can see this is not true in this instance). You may want to check directly with them and ask, they would likely have the answer.