How Much Does an Annual Physical Exam Cost?

Last Updated on March 7, 2024
Written by CPA Alec Pow | Content Reviewed by CFA Alexander Popinker

Getting a yearly physical exam is one of the most beneficial things you can do for your health. During this preventive visit, your doctor will check your vitals, assess your risk factors, run routine screening tests, and address any health concerns—all with the goal of spotting issues early when they’re most treatable.

But before scheduling your next checkup, you may be wondering: What will this essential preventive care service actually cost me?

The specific price depends on several factors, which we’ll explore in detail below. By understanding what goes into pricing an annual physical and learning how to maximize your insurance coverage, you can access this vital healthcare at a reasonable cost.

Read on for an in-depth look at how much you can expect to pay for your annual wellness exam.

How Much Does an Annual Physical Exam Cost?

On average, without insurance, an annual physical exam may cost anywhere from $100 to $300 or more. However, with insurance coverage, the out-of-pocket cost for the exam could be significantly lower, often just the copay or coinsurance amount dictated by the insurance plan.

The cost of an annual physical exam can vary depending on factors such as location, healthcare provider, and insurance coverage. It’s advisable to check with your healthcare provider and insurance company to understand the specific costs associated with your annual physical exam.

According to Solv Health, the average cost for an annual physical in the U.S. without insurance is $199, with prices typically ranging between $50 to $200.

As we can see on the Sidecar Health Care Calculator website, annual physical exam procedure cash costs range between $353 and $502 depending on the type of care facility and state. In New York, the cash costs start at around $458 but can be up to 40% less when using Sidecar Health Insurance.

At the Physical Exam Center NYC, a physical exam costs $150, with additional nominal fees if blood or urine tests are required.

Annual Physical Exam Overview

Let’s start with what exactly makes up an annual checkup. While the specific components may vary based on your individual needs, here are some standard elements:

• Medical history review: Your doctor will ask about your family history, medications, allergies, prior surgeries, and more.
• Vital sign measurements: Blood pressure, pulse, respiration rate, oxygen saturation, height and weight, BMI, and temperature.
• Physical exam: A head-to-toe assessment of your eyes, ears, nose, throat, heart, lungs, reflexes, skin, and more.
• Preventive screenings: Based on your age and risk factors, your doctor may order routine lab tests, immunizations, cancer screenings (mammogram, colonoscopy), bone density scans, STD tests, and cardiovascular disease screens.
• Medication review: Your doctor will assess what prescriptions you’re taking and adjust dosages or orders as needed.
• Health counseling: Your provider will offer guidance on diet, exercise, smoking cessation, mental health, and any other concerns.

While it may seem simple on the surface, your annual physical is a comprehensive review aimed at identifying any red flags early on and optimizing your health through preventive care.

Factors That Influence Annual Physical Exam Costs

Several important factors affect how much you’ll pay out of pocket for your yearly wellness visit. Prices can vary widely based on:

• Geographic location: Costs in urban areas like New York City or San Francisco will be higher than in rural areas due to overhead expenses and labor costs.
• Provider practice setting: Hospital-based clinics often charge more than independent primary care offices.
• Scope of services: More extensive lab tests, exams, procedures, and specialist referrals will increase the price.
• Insurance coverage: Those with robust benefits through Medicare, Medicaid, or private plans pay less than the uninsured.

You might also like our articles about the cost of TB tests at CVS, chiropractic treatment, and EMG tests.

To give you a sense of the cost range, here are some average prices for basic annual physical exams by location and provider:

• Small town clinic: $125-$250
• Suburban private practice: $150-$350
• Large city hospital: $300-$500

Of course, this does not reflect any additional costs for follow-up services. We’ll break down how insurance coverage and additional procedures impact your bottom line next.

Insurance Coverage for Annual Physical Exams

One of the biggest factors affecting out-of-pocket costs for your yearly physical is what type of health insurance coverage you have. Here’s an overview of how different plans handle no-cost preventive services like an annual wellness visit:

• Medicare Part B: Covers one exam annually at 100% if your doctor accepts the assignment. You may pay 20% coinsurance for services like lab tests performed during the visit. Medicare Advantage plans may offer additional no-cost screenings.
• Medicaid: Fully covers an annual physical exam with no copay or coinsurance in most states. Optional screenings may involve small copays of $1-$4.
• Private Insurance: The Affordable Care Act requires coverage of preventive services like immunizations and screenings at no cost. But you may pay copays or deductibles for follow-up exams or lab work.

Understanding how your insurance plan handles preventive care is key to avoiding unexpected charges. Be sure to ask in advance about what exactly will be covered at no cost during your annual visit.

Out-of-Pocket Costs for Uninsured and Underinsured Patients

If you are uninsured or have a high-deductible health plan that leaves you paying out of pocket for services, annual physical exam costs can vary widely. Prices depend on what specific tests, screenings, and procedures are performed. Some general price ranges:

• Basic preventive exam: $100-$300
• Basic lab tests: $50-$200
• Immunizations: $25-$75 per vaccine
• Imaging scans: $100-$500
• Specialist referral: $100-$500

Here are some strategies to save on your annual wellness visit if you lack insurance coverage or have high cost-sharing:

• Ask your doctor to only order essential recommended tests to limit expenses
• Check prices at community health clinics with sliding fee scales
• See if any nearby hospitals offer free screening days
• Look into medical cost-sharing groups and healthcare-sharing ministries
• Inquire about hardship discounts or financial assistance programs

Shopping around, being selective with screenings, and tapping financial help resources can make annual exams more affordable for uninsured and underinsured patients.

Additional Costs Beyond the Basic Physical Exam

While your annual wellness visit itself may be covered, don’t be surprised if additional services recommended by your doctor come with extra costs. Some examples include:

• Vaccinations: A standard flu shot may average $40 without coverage. More extensive immunizations like shingles or pneumonia vaccines can cost over $200 per dose.
• Lab tests: A basic metabolic panel averages $100 with insurance. More extensive testing like a complete blood count could be $300 or more.
• Imaging: A standard chest x-ray can range from $100-$500 out-of-pocket depending on the facility. Advanced scans like a CT run $1,000-$5,000.
• Specialist referrals: If your PCP suspects an issue like heart disease, a cardiology consult might cost $250-$500 out-of-pocket. Certain procedures could be much more.
• Prescriptions: Your doctor may prescribe new medications for issues found during your exam, which could cost $30 per generic script or $200 or more for brand name drugs.

Before agreeing to additional services, understand costs and insurance coverage. Ask if follow-up care is essential or can wait until you budget and prepare financially.

Reduce Annual Physical Exam Costs

If the price tag of your recommended annual wellness visit gives you sticker shock, here are some savvy ways to minimize the costs:

• Use telehealth instead of in-office visits, when possible, for convenience and lower prices.
• Ask your provider if they offer packages or discounts for combining services into one annual visit.
• Consider an independent lab for screenings instead of hospital labs to save up to 50%.
• Take advantage of workplace or community health fair blood drives and health screenings.
• Ask about cash discount rates which are usually lower than what insurance copays would be.
• Use tax-advantaged funds like HSAs or FSAs to cover out-of-pocket medical expenses.
• Check if your employer offers incentives or reduced rates for annual physicals and health assessments.

Getting preventive care shouldn’t break the bank. With some smart preparation and research into the most affordable options in your area, you can limit your out-of-pocket costs for this vital annual wellness visit.

Final Words

Regular preventive healthcare like an annual physical exam is one of the best investments you can make in your long-term health and wellbeing. But costs should not be a barrier to accessing this essential care.

Now that you understand the pricing structure of annual wellness visits and have strategies to maximize your insurance coverage and find deals, you can feel confident scheduling your next checkup without busting your budget.

Remember, preventing disease through routine screening and catching issues early before they become dire can save you thousands down the road. An ounce of prevention is worth a pound of cure when it comes to your physical health and financial wellness!

Frequently Asked Questions

What questions are asked in a physical?

During an annual physical exam, your doctor will ask about your current health status, medications, family medical history, lifestyle factors like diet and exercise, and any symptoms you may be experiencing.

They will also ask about mental health, sleep patterns, sexual health, and safety measures like seat belt use. Be ready to answer any questions honestly so your doctor can fully assess your well-being.

What is the purpose of a routine physical exam?

The main purpose of an annual physical exam is preventive care. By checking your vitals, assessing risk factors, and running screening tests, your doctor can spot early warning signs of more serious conditions like heart disease, diabetes, or cancer.

Catching issues early makes them much easier to treat. A wellness visit also gives you a chance to establish care, address concerns, update medications, and get advice to improve your health.

How do I prepare for my physical?

To prepare for your annual exam, gather your medical records, make a list of any current symptoms or concerns, and write down any medications and supplements you take. Avoid alcohol and strenuous exercise for 24 hours prior.

For a fasting blood draw, avoid food for 8-12 hours beforehand. Bring your insurance card and photo ID. Arrive early to complete any intake forms. And follow your doctor’s instructions if they advise coming with a full bladder for ultrasound tests. Preparation helps ensure a thorough and efficient appointment.