Even if you feel fine, regular checkups, at least every 2 years, are important to maintaining good health. Preventive care is covered under most plans at 100 percent, which means no out-of-pocket cost to you. Even employment physicals can be covered as preventive. However, if you have pain or other symptoms, the visit could be billed as diagnostic, meaning it will not be billed as preventive.


What Happens?

Just like when you were a kid, your doctor will check your vitals, like blood pressure, heart rate, respiration, and temperature. The adult version of the checkup might also include a check of the testicles, penis, and prostate, and for hernia.

The doctor might order lab tests, including blood work and urinalysis. Depending on your family history, age, and other risk factors, you might be screened for cholesterol, blood-sugar levels, and sexually transmitted diseases. Colonoscopy is another common preventive procedure.

The preventive exam is also the place to get vaccines, starting with the human papillomavirus (HPV) vaccine. This is covered and recommended between ages 10 and 21. It's a good idea to get a flu shot every year along with any vaccines recommended for you.

The checkup is also a good time to talk about personal risks and history. For example, if you are or have been a smoker, your doctor might recommend an aortic ultrasound, which is covered.

Talk with your doctor if you have personal concerns. For example, mammograms are not typical for men, but if you have a family history of breast cancer, the screening might be appropriate for you and is covered.

Your physical exam will vary based on your age and risk. Your health plan allows you and your doctor to determine which tests are best for you and which you can skip. Procedures and tests that qualify as preventive care can include:

  • Infection and disease screening, including chlamydia, gonorrhea, syphilis, or other infections.

  • Sexually transmitted infections counseling for sexually active men

  • HIV screening and counseling for sexually active men at higher risk

  • Hepatitis B and C testing for men at higher risk and Hep C screening for men born before 1965.

  • Colorectal cancer screening with colonoscopy starting at age 50 years old.

  • Tobacco use screening, counseling and interventions

  • Lung Cancer: Screening -- Adults Ages 55-80 who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years

  • Abdominal Aortic Aneurysm: Screening -- Men Ages 65 to 75 Years Who Have Ever Smoked.

  • Alcohol use screening, counseling and interventions

  • Drug use screening, counseling and interventions

  • Depression screening and counseling

  • Domestic and interpersonal violence screening and counseling

  • Healthy diet and physical activity screening and counseling

  • Blood pressure screening

  • Obesity screening and counseling

  • Type 2 Diabetes screening (fasting blood glucose)

  • Lipid panel every 5 years if results historically normal

  • Immunization vaccines for adults - doses, recommended ages, and recommended populations vary: Hepatitis, Hepatitis B, Herpes, Herpes Zoster, Human Papillomavirus, Influenza (Flu Shot), Measles, Mumps, Rubella, Meningococcal, Pneumococcal, Tetanus, Diphtheria, Pertussis,
    Varicella.

  • Aspirin preventive medication: adults aged 50 to 59 years with a ≥10% 10-year cardiovascular risk.

Keep in mind, though, that if your doctor orders follow-up tests or procedures based on signs and symptoms, those are billed as diagnostic rather than preventive and would not qualify as a free preventive exam. Which means you could be charged for additional services.

Your health plan covers preventive care services as required by state and federal law. For more information, please review the "A" and "B" rated services on the United States Preventive Task Force, immunizations recommended by the Centers for Disease Control and Prevention and preventive care and screening recommended by the Health Resources and Services Administration. See the list on healthcare.gov.