What to Expect at a Preventive Care Exam and What Insurance Normally Covers

What to Expect at a Preventive Care Exam and What Insurance Normally Covers

Valley’s primary care clinics are your medical home for health and wellness. Your primary care team is led by your primary care provider—a physician, physician assistant or nurse practitioner. Your primary care team will work with you to monitor and improve your health through all life’s stages, while coordinating care with specialty physicians as needed. While following proven quality standards, your primary care team focuses on preventive care and living well with chronic conditions.

A routine preventive exam, sometimes called a “wellness check-up” or “annual physical,” is an important element of primary care. If you are insured, your insurance carrier decides which health services are included in a preventive care visit/routine annual exam at no extra cost to you as the covered patient.

What’s included in a preventive or routine exam?
Insurance plans generally cover the following preventive exam services once a year at no cost to the patient:

  • Physical exam based on your age, gender and health status
  • Assess your risk level for health problems and diseases
  • Get advice about screening tests/vaccines for your age and sex

What’s the benefit of a preventive or routine exam?
The physical exam, as well screening for health problems and diseases, can:

  • Lead to better detection and treatment of chronic illnesses such as depression, diabetes and high blood pressure
  • Help prevent illness by staying current with recommended vaccinations
  • Help detect disease by reminding you to get recommended screenings

What’s not covered by insurance during a preventive care exam?
During a preventive exam, your provider is happy to provide other services or talk about other concerns you may have. However, it’s important to know that talking about or managing issues outside of generally covered, routine care services may not be covered under your insurance’s preventive care benefitsand you may have out of pocket expenses.

What services are generally NOT considered part of preventive exam coverage?

  • Evaluating and managing new or worsening health conditions (i.e. cold symptoms, a rash, muscle pain or chronic conditions like cholesterol or diabetes)
  • Diagnostic tests to assess a new condition or to monitor an existing medical condition

How do I keep my visit only about preventive care?
If you want to limit your exam to preventive care only, please let your provider know at the beginning of your visit. To talk about other concerns at another time, you are welcome to schedule a separate appointment with the clinic or via MyChart.

What if I want to talk about issues outside those normally covered under a preventive exam?
If you decide it’s more convenient to discuss any other health concerns at the preventive exam, you are welcome to do so—just know ahead of time that your insurance carrier may require out of pocket expenses, such as a co-pay, for the visit. 

Preventive care exams may be scheduled with your primary care provider through MyChart or call your primary care clinic.

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Valley Medical Center's Marketing and Community Outreach Office