What to Know About Well Woman Exams: What’s Covered and What’s Not
Regular health check-ups play a crucial role in maintaining overall well-being. For women, well-woman exams are an essential part of preventative care. They’re designed to address various aspects of women’s health and provide a comprehensive evaluation of their physical and emotional well-being.
Well-woman visits are different from an “annual physical exam.” In this article, we will explore why they’re different, what to expect from a well-woman exam and the differences in insurance coverage between the two types of healthcare check-ups.
What is a well-woman visit?
Simply put, the goal of a well-woman visit is to keep you well.
It is a regular appointment with a healthcare provider that focuses on preventive care for women of all ages—starting from the time a woman is sexually active and continuing until the age of Medicare eligibility.
These visits are an opportunity to discuss and evaluate various aspects of a woman’s health, including physical, emotional, and reproductive well-being. They’re tailored to meet the specific needs of women at different stages of life, providing personalized care and health education.
By identifying and addressing potential health concerns early on, well-woman visits aim to prevent the development of more serious conditions. These visits also help healthcare providers establish open and trusted relationships with their patients, fostering effective communication and personalized care.
While well-woman visits focus on preventive care, they are not intended to manage existing medical conditions such as hypertension, thyroid disorders, or diabetes.
How is a well-woman visit different from an annual exam?
Many patients often refer to their visits with their OB/GYN as their ‘annual exam’, but the more accurate term is the ‘well woman exam’ or ‘well woman visit’. While we encourage regular visits to ensure you remain healthy, it does not always mean it has to be done annually.
Check with your insurance to understand how frequently you can obtain preventive services. A well-woman visit has a specific insurance billing code, which determines the topics and services insurance will cover. It is a specialized appointment dedicated to addressing women’s specific health needs. It encompasses a broad range of preventive services, including reproductive health screenings, counseling, and education.
Medicare, which is mostly for adults ages 65 and older, provides a limited gynecologic exam, as well as an “annual wellness visit” that is available to both male and females.
How often should I schedule a well-woman visit?
Most insurance plans cover these visits once a year or every other year. Read more about when to see your OBGYN.
Will my appointment be covered by insurance?
The Affordable Care Act requires insurance plans to cover 100% of the cost of preventative care, such as a well-woman visit. Preventative care includes screenings and assessments, but not the management of existing medical conditions.
Discussions of problem-oriented issues may not be fully covered by your insurance. While not a complete list, some of the more common issues are:
- Back pain
- Sleeping problems
- Mental health concerns, like anxiety
- Abnormal bleeding
- Perimenopausal symptoms
- Dermatologic concerns
- Hair loss
- Pain with intercourse
What items are included in a well-woman visit?
During a well-woman visit, a physician conducts various screenings and assessments to monitor and address specific health concerns. Common components of a well-woman visit include:
- Monitoring BMI (Body Mass Index) and vital signs
- Reviewing menstrual history
- Cervical cancer screening, commonly known as a Pap smear
- Checking immunization status and providing necessary vaccinations
- Conducting mood screenings and assessing domestic violence risks
- Discussing wellness issues such as exercise and diet
- Breast cancer screening, recommendations for mammography and breast exam (if not declined)
- Colon cancer screening (depending on age)
- Screening for sexually transmitted infections (STIs) if needed
- Bone density testing if needed to assess osteoporosis risks
- Screening for alcohol / substance abuse and smoking habits
- Discussing birth control / contraception options
- Cholesterol and glucose screening (note: lab tests may or may not be covered by insurance)
What is typically not included during a well-woman visit?
While you are welcome to ask your physician questions and discuss medical issues, topics related to managing existing medical conditions are not considered preventative care and are not required to be covered by insurance during a well-woman visit.
Instead of discussing existing conditions at your well-woman exam, we recommend that you schedule a follow-up visit to discuss problem-oriented conditions like the ones listed previously.
Understanding the Affordable Care Act, preventative care and your insurance
No one likes surprise bills! That’s why it’s so important to be familiar with the specific details of your insurance plan and what is covered for different kinds of health checkups.
The Affordable Care Act (ACA) expanded access to preventive services. Under the ACA, preventive care services for women are required to be covered by most insurance plans without charging a copayment, coinsurance, or deductible. Check with your insurance provider to confirm the coverage details related to well-woman visits.
Learn what your insurance plan includes by:
- calling the 1-800 number on the back of your insurance card
- looking at your plan book during open enrollment period
- emailing your insurance company
If you have any concerns about the cost of services, ask your clinic for an estimate of fees for the specific components of your well-woman visit. By law, healthcare providers are required to provide estimates of fees upon request. This transparency helps you to make informed decisions and ensures that you have access to the necessary healthcare services as mandated by the ACA.
For example, if you have questions about menstrual irregularity, you could ask what an ultrasound or blood tests will cost. If your insurance doesn’t cover the tests or care you need, we will work with you to create a payment plan.
Common questions patients ask during well-woman appointments:
- What screenings or tests do you recommend for my age and health condition?
- Are there any lifestyle changes I should consider to improve my overall health?
- Can you provide more information about contraception options and their suitability for me?
- Are there any additional preventive measures or vaccinations I should consider?
- What resources or support groups are available for specific health concerns I may have?
- How can I maintain a healthy weight and lifestyle?
Our goal is to help you stay well
Well-woman visits are vital for women’s preventive care. They offer an opportunity to monitor your overall health and receive important screenings. By prioritizing regular well-woman visits, you can take proactive steps toward maintaining your well-being and leading a healthy life.
