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CostHelper > Health & Personal Care  > Medical Specialties & Departments > Annual Physical

Annual Physical Cost


How Much Does an Annual Physical Cost?

 
average costWith Health Insurance: $10-$50 Copay or 10%-50% Coinsurancehigh costWithout Health Insurance: $50-$200+
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An annual physical is a routine checkup typically administered by a family or general practitioner or general internist. Though it is one of the most common reasons why adults see a doctor, a 2007 analysis in the Archives of Internal Medicine[1] suggested that, for healthy men and women, the costs of the visits outweigh the benefits, since most preventive screenings and counseling occur at other points in the year. However, the American Academy of Pediatrics does recommend that children and young people[2] age three to 21 receive a checkup annually. Children and toddlers under 3 typically require more frequent visits.

Typical costs:

  • An annual physical is typically covered by health insurers, many of which offer it for free. Most CIGNA health plans[3] , for example, cover the entire cost of the exam. The primary factor driving cost is time spent to both see the physician and use the facility.
  • Patients who are covered by health insurance, but are not entitled to a free visit under their plan, face a copay of $10 -$50 or more, or coinsurance of 10%-50% or more. According to the Agency for Healthcare Research and Quality[4] , the national average for copays is about $19. Patients covered by United One[5] can expect a $35 copay, while those with CareFirst Blue Cross Blue Shield[6] can expect a $25 copay.
  • For patients without health insurance, an annual physical typically costs $50-$200 or more. According to The Medical Expenditure Panel Survey[7] , a set of large-scale surveys on the use and cost of health services conducted by the Agency for Healthcare Research and Quality, the average price of an office visit for an uninsured patient is $199. For example, in Minnesota's Park Nicollet Health Services hospital system, patients can expect to pay from $169 for an infant's physical to $222 for a senior's physical.
Related articles: Blood Pressure Monitor, Blood Tests, Biopsy, Hearing Test, Eye Exam

What should be included:
  • Annual physicals, according to the Archives of Internal Medicine analysis, last an average of 23.1 minutes. But how individual doctors structure that time can vary a great deal.
  • The National Library of Medicine[8] says an annual physical for an adult may include cholesterol and blood pressure screenings, vaccinations, testicular or prostate exam for men, and a breast exam for women. Doctors also frequently provide weight-loss or other lifestyle counseling.
  • A child's annual visit[9] will typically focus on whether the child is meeting developmental milestones and includes evaluations of height, weight and blood pressure. The doctor may also address the child's diet, exercise habits and sleep patterns, and administer recommended vaccines.
Additional costs:
  • The Affordable Care Act[10] , signed into law in 2010, calls for health insurers to cover certain preventive screenings and services, which patients might receive during a physical, such as blood pressure and cholesterol tests, routine vaccinations, and mammograms, at no additional cost to the patient. However, "grandfathered" plans, or plans that existed before the act was passed in 2010, are exempt from many of the requirements. Moreover, additional testing and services received during the annual physical may not be covered, depending on the insurance plan.
  • The American Academy of Family Physicians [11] recommends that patients read their insurance policy before the exam, so they'll know what their insurance company will pay for before they receive a service or get tested.
Discounts:
  • For patients without health insurance, walk-in clinics, a mainstay for corporations like CVS and Walmart, offer services at significantly cheaper costs. Walmart's Get Well Stay Well visits[12] , which include some preventive and routine health services such as cholesterol and blood pressure screenings, cost $65 or less. CVS's MinuteClinics, which are staffed by nurse practitioners and physician assistants, offer physicals for adults and children for $59.
  • Children, teens and their parents may qualify for no-cost or low-cost health insurance coverage through Medicaid[13] and the Children's Health Insurance Program [14] which covers doctor visits and vaccinations. The federal government's Vaccines for Children program[15] , as well as patient assistance programs run by major pharmaceutical companies such as Merck[16] and GlaxoSmithKline[17] also help eligible patients get free vaccines.
  • Some hospitals and doctors offer discounts or special programs for uninsured patients. For example, in Sutter Health's hospital network[18] in Northern California, low-income uninsured patients may qualify to receive free care, and mid-income uninsured patients are billed at rates lower than those charged to private insurance companies.
Shopping for an annual physical:
  • The AAP has a referral tool to help parents locate pediatricians near them at no cost. And, though the American Medical Association cannot recommend individual physicians, it does have a DoctorFinder[19] tool to help patients search for physicians by name, location or specialty for free.
Material on this page is for informational purposes only and should not be construed as medical advice. Always consult your physician or pharmacist regarding medications or medical procedures.
 
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What People Are Paying - Recent Comments
Annual Physical - Excesive Cost
Amount: $481.00
Posted by: Mireya Linares in Reedley, CA.Posted: October 7th, 2014 08:10AM
Doctor/Medical Center: Reedley Community Care ClinicInsurance Carrier: United Health
I went to my annual physical, at same time my company was updated our medical insurance, however, even I told the nurse "Do not do any test that is not cover my insurance" and "I don't need a Thyroidal test, it was done last year". 2 months later I got the bill for all the lab test she order which do not qualify as Preventive Care. Same reason my Insurance is refuse to paid 100% of the bill because they were not preventive care. The clinic refused to change the order, because they don't know the what qualify and what not.
My problems are 2 things: a) A nurse decided the test to run, and I don't have the right to said Not, she selected without my acknowledge.
b)The Clinic made sign a letter where I am responsible for all the extra costs that it is not cover by my insurance, otherwise I don't get service, but the letter never give the choose to preapprove tests done or to verify if I can afforded it.
Thank you for reading this, I hope help others.
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External Resources:
  1.  archinte.jamanetwork.com/article.aspx?articleid=486857
  2.  www.healthychildren.org/English/family-life/health-management/Pages/Well-Child-Care-A-C...
  3.  www.cigna.com/customer_care/healthcare_professional/medical/pdf/807467_d_PreventiveHeal...
  4.  meps.ahrq.gov/mepsweb/data_files/publications/st209/stat209.pdf
  5.  www.ehealthinsurance.com/health-insurance-companies/united-healthcare-maryland/benefit-...
  6.  www.ehealthinsurance.com/health-insurance-companies/carefirst-bcbs-virginia/benefit-det...
  7.  meps.ahrq.gov/mepsweb/data_files/publications/st318/stat318.shtml
  8.  www.nlm.nih.gov/medlineplus/ency/article/002125.htm
  9.  www.healthychildren.org/English/family-life/health-management/Pages/Routine-Doctor-Visi...
  10.  www.healthcare.gov/law/features/rights/preventive-care/index.html
  11.  familydoctor.org/familydoctor/en/healthcare-management/insurance-bills/health-insurance...
  12.  www.walmart.com/cp/Walmart-Clinics/1078904
  13.  www.insurekidsnow.gov/medicaid/index.html
  14.  www.insurekidsnow.gov/chip/index.html
  15.  www.cdc.gov/vaccines/programs/vfc/parents/default.htm
  16.  www.merck.com/index.html
  17.  www.gskforyou.com/
  18.  www.sutterhealth.org/about/ab_uninsured.html
  19.  /extapps.ama-assn.org/doctorfinder/recaptcha.jsp
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