At Passion Health Primary Care, we believe preventive care should be accessible and affordable. Annual physical exams are an essential part of maintaining your health — and many insurance plans help cover these important visits.
Understanding your coverage ahead of time can save you confusion, reduce out-of-pocket costs, and ensure you get the care you deserve.
What Insurance Typically Covers
Most health insurance plans, including Medicare and Marketplace plans, cover annual preventive exams at no additional cost when delivered by an in-network primary care provider.
This often includes:
Comprehensive physical exam
Health history review
Blood pressure check
Routine blood tests (as recommended)
Age-appropriate screenings
Preventive counseling (diet, exercise, tobacco cessation)
Many plans cover these services 100%, meaning you pay no copay when the visit qualifies as a preventive exam.
How Preventive Vs. Sick Visits Are Covered
It’s important to know the difference:
Preventive Visit
Scheduled annual exam
Focus on screening and prevention
Usually no copay/deductible for covered plans
Sick or Problem-Focused Visit
Symptoms or illness concerns
May involve additional tests or treatment
Copays, deductibles, or coinsurance may apply
If your annual exam includes evaluation of a specific concern or sickness, your insurer may bill part of the visit as “medical care,” which can lead to standard cost sharing.
What You Should Do Before Your Visit
To make sure your preventive visit is covered:
1. Check Your Insurance Benefits
Call your insurance plan or check your member portal to verify preventive care coverage.
2. Confirm With Our Office
Our staff can help verify your benefits and explain what’s covered.
3. Bring Your Insurance Card
Having your card ensures accurate billing and faster claims processing.
4. Tell Us About Additional Concerns
If you have health issues you want addressed, let us know — so we can help separate preventive care from medical care appropriately.
Medicare & Preventive Exams
For Medicare beneficiaries:
Medicare Part B generally covers one annual wellness exam
Includes preventive screenings and health risk assessments
No copay if provider accepts assignment*
*You may have costs for additional services ordered during the visit.
Our team at Passion Health Primary Care will guide you through Medicare coverage and answer your questions.
Marketplace, Employer & Private Plans
Most employer-sponsored and Affordable Care Act (ACA) plans follow national preventive guidelines.
That means:
No cost share for annual physical exams
Coverage for age-appropriate screenings
Benefits for lifestyle counseling
Always check your specific plan to see full details.
Common Out-of-Pocket Expenses
You may pay out of pocket if:
Your visit includes diagnostic or sick visit services
You have not met your deductible
Tests or procedures are ordered that aren’t preventive
You are out of network
If this occurs, we’ll explain your options before billing.
Making Insurance Simple for You
Our team will:
1.Verify your benefits before your visit
2.Explain your coverage and any expected costs
3.Bill your insurance accurately
4.Answer questions about claims and statements
We want you to focus on your health, not your bill.
Ready for Your Annual Physical?
Schedule your appointment with Passion Health Primary Care today — and let us help you maximize your insurance benefits while keeping your health on track.
