health coverage

Do Health Coverage Plans Usually Cover Routine Checkups?


Benjamin Franklin once said, “An ounce of prevention is worth a pound of cure.”

Being sick is not the only reason to get yourself checked by your Primary Care Provider. In fact, it is a preventive measure to avoid any future medical concerns. As per the suggestion of the National Institute of Health, every adult should go for regular health checkups, even if they feel fine. There are several reasons which are stated for frequent routine checkups:

  • To determine if there is a risk of any medical condition
  • Rule out diseases if any
  • Prompt you to lead a lifestyle that is healthy and risk-free
  • Check whether any vaccines are due

Health Insurance plans

Regular checkups are vital to ensure good health. Still, the question arises whether or not health coverage plans cover these? Out of more than 3 lac people surveyed in 2018, US Census Bureau concluded that 91.5% of them had health insurance. Private health coverage companies insured 67.3 % of them.

Health insurance coverage funds the health care costs of individuals, reducing medical expenses.

The goal of health insurance is to provide individuals with top-quality healthcare without burdening them with financial strain. It also makes the best healthcare services accessible to the coverage holders. 

In life, every one of us needs medical care at one point or the other. Getting sick is part and parcel of life. It is highly recommended to save oneself from usual and unexpected medical costs by opting for a reputable Health Coverage provider.

Do health insurance plans cover routine checkups as well?

Preventive checkups are usually covered 100% by health plans. Required by the law Affordable Care Act(ACA), health coverage plans must include essential health benefits that also include preventive care.

Note: The costs of routine preventive examinations will be covered only if the medical care is delivered by a practitioner from your insurance plan’s network.

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Your health insurance may cover the following type of routine checkups:

  • Annual physical exam: a yearly visit to your doctor’s office helps you to rule out several conditions if you are at a high risk of them. You can also keep track of your weight and height.
  • Pap smears: Women are required to take a pap smear test to check for cervical cancer.
  • Mammogram: Women over 40 years of age need to undergo mammography scans so that Breast cancer can be ruled out.
  • Colonoscopy: People who are at a high risk of developing colorectal cancer are required to have a colonoscopy every five years.
  • PSA tests for prostate cancer screening: A blood test recommended for men who are at risk of prostate cancer.
  • Routine blood work to screen anemia: Early detection of anemia in kids is possible by regular CBC tests. If detected early, anemia can be overcome with effective treatment.
  • Obesity screening and diet counseling: A prevalent cause for concern in most Americans, obesity causes multiple diseases that can be easily avoided by diet counseling.
  • Tests to rule out Diabetes, BP, and Cholesterol: You can be at high risk of these diseases if they run in your family or if you are obese. Routine checkup with your primary care provider can help you be one the right side of the ranges for these tests.
  • Tuberculosis screening: Even without symptoms, some people can be at high risk for tuberculosis. The only way to detect it early or prevent its onset is by getting yourself assessed for the disease regularly.
  • Hepatitis B and C screening: People who were not vaccinated against Hep-B or C need to have regular checkups to prevent developing them.
  • ECG, EKG, Xrays: Your checkup may include these tests to determine your heart condition, specifically if you have a probability of developing cardiovascular diseases.
  • Immunization schedules: Any vaccination that got missed can be updated if you regularly go for health checks and have an immunization record. Flu-shots are also covered under this category.
  • Osteoporosis screening: Many men and women of advance age are at a high risk of osteoporosis, for which they have to undergo regular bone density tests.
  • Pre and post-pregnancy care: prenatal, antenatal, and postnatal checkups ensure the wellness of the mother and her baby. Avoiding these visits is not advisable as these routine checkups prevent the development of any complication and make the process much safer.
  • UTI screening: you may have an ongoing infection that can be detected in your regular checkups, preventing you from suffering from advance stage symptoms.
  • Yearly urinary incontinence screening: Incontinence can be a nuisance not only for older women but young ones as well. To stay safe from it, a frequent checkup is advised.
  • Well-baby screening: If the newborn baby gets checked by the pediatrician regularly, it will help avoid any conditions that can affect the baby’s wellbeing.
  • Oral health assessment of children: Dental problems are prevalent in children. Regular oral checkups can detect any cavity or other issues risking oral health.
  • Vision assessment: Frequent eye checkups can be beneficial to determine if your eyesight is weak, or there is any other condition with your eye.
  • Skin checkups: This one is specifically for those who work outdoors for long periods or are exposed to a particular element that can damage your skin. A visit to the dermatologist’s office will help you stay safe from any skin conditions.
  • Cost of doctor’s visit: most of the Health coverage plans also give the patient relief from paying the doctor’s fee.
  • Medications: The insurance providers thankfully covers prescriptions.
  • Treatment costs: if you or your family requires treatment, your health coverage will pay for that as well.
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Routine physical examinations

Do not cover the tests, and treatment of any disease has been diagnosed after your regular checkup. Monitoring and Managing a disease comes under diagnostic care.

You don’t need to pay anything for your routine checkups, not even if you haven’t met your yearly deductible. But, regular care coverage may vary from plan to plan. You can confirm with your health coverage provider about what type of preventive checkup benefits you can get with your current policy.

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