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Navigating Your Annual Wellness Exam

An annual wellness exam is designed to review your general health, detect issues, prevent illness and improve overall well-being. Wellness exams are typically covered at 100% by most major health insurances. However, costs can vary depending on a variety of factors. Learn what is covered in an annual wellness visit (and what is not) so that you can anticipate costs and maximize the time with your provider.

In order to cover annual wellness exams at 100%, some insurance companies require 365 days between wellness visits; others are once per calendar year. It’s always best to verify your benefits with your insurance provider.

 

What is typically covered in an annual wellness visit?

The following items are typically covered by insurance:

• Prevention-focused evaluation
• Screening for illness or medical problems
• Review of medical and family health history
• Immunization review and updates
• Age-appropriate health screening (see recommendations by age)
• Evaluation for signs of depression
• Contraceptive counseling or preconception counseling
• Review and update of current providers

 

What is not typically covered under preventive wellness benefits?

While medical providers are trusted allies in your healthcare, they are required to document each visit, and you could be charged for conversations and/or services outside of the scope of what most insurance policies include in a wellness visit. The following items are typically NOT covered in an annual wellness visit and may incur additional charges:

• Medication management (renewing or changing existing prescriptions) for chronic conditions
• New health concerns (flu, COVID, ailments, sinusitis, etc.)
• Existing health concerns, such as diabetes, chronic pain, high blood pressure, etc.
• New medications or prescriptions for new health concerns

 

Bloodwork and Vaccinations

Most insurance policies cover preventative care bloodwork and vaccinations, but there are exceptions and some lab work can be charged to the patient’s deductible. A complete blood count (CBC) and bloodwork used to check cholesterol levels and diabetes markers are typically covered, but blood chemistry tests like kidney or liver function, or vitamin D or iron levels, are not considered preventative care. Flu shots and most vaccinations are covered at 100%. Again, it’s best to verify your benefits with your insurance provider.
 

Financial Resources

If cost is a barrier, consider financial assistance to support your care. Vail Health’s financial assistance program is available to anyone who does not have sufficient resources to pay for services. Navigating the cost of healthcare can be difficult, so understanding your insurance policy is critical. When in doubt, contact a representative from your insurance company with your questions. 

Remember, preventive maintenance is the best way to stay ahead of disease and keep healthcare costs low. Annual wellness exams are meant to diagnose issues early on so that they don’t become more serious, or more costly.