health · 7 min read
What Does a Yearly Physical Cost if It's Supposed to Be Free?
An annual physical is usually $0 under the ACA, until a lab test or a new complaint gets billed as a separate visit.
By WarmLark Editors · Updated October 2026
If you have private insurance and see a doctor in your plan’s network, the yearly physical itself should cost you $0. The bill comes from what gets added to it, like a new problem you bring up, a lab test ordered to check a symptom, or a doctor who turns out to be outside your network.
Without insurance, you pay the full price. New Hampshire’s state price site, NH HealthCost, puts the average charge for an adult preventive visit at $319 for ages 18 to 39 and $368 for ages 40 to 64, before any discount.
The law behind the $0 checkup
The free part comes from Section 2713 of the Public Health Service Act, added by the Affordable Care Act. It tells most private plans to cover certain preventive care with no copay, no coinsurance and no deductible.
Three federal lists name the care that qualifies for you: screenings rated A or B by the U.S. Preventive Services Task Force, vaccines recommended by the CDC’s ACIP committee, and HRSA’s guidelines for women and children.
That whole setup was in danger until June 27, 2025.
In Kennedy v. Braidwood Management, a group of Texas businesses and individuals argued that the Task Force members were appointed in a way the Constitution doesn’t allow. The Supreme Court ruled 6 to 3 against them, in an opinion by Justice Brett Kavanaugh, and the $0 rule stayed in place.
What it costs with no insurance
NH HealthCost builds its estimates from real claims paid between April 2024 and June 2025, raised 5 percent for inflation. It lists a charge for each provider, and for hospitals it also shows the minimum discount they give uninsured patients.
For a preventive visit at ages 40 to 64, HCA’s Portsmouth Regional Hospital lists $305 and takes off 91 percent, which leaves $27. North Country Healthcare’s hospital in Berlin lists $313 but takes off only 37 percent, leaving $197. Concord Hospital goes from $420 to $139. Dartmouth Health’s medical center in Lebanon lists $632 and ends at $424.
If you’re paying cash, the listed charge tells you very little, so ask about the uninsured discount before you ask about the price.
What’s free and what gets billed
Your doctor’s office sends your insurer a list of codes, one line for each service. The checkup has its own codes, 99385 to 99387 for a new patient and 99395 to 99397 for an established one, split by age. Your insurer checks each other line separately for a $0 price.
| On the claim | What you usually pay | The rule behind it |
|---|---|---|
| Preventive visit (99385 to 99387, 99395 to 99397) | $0 in network | Section 2713, when prevention is the main purpose of the visit |
| Screening with a Task Force A or B grade, such as a blood pressure check or a depression questionnaire | $0 in network | Section 2713 |
| Vaccine on the ACIP schedule | $0 in network | Section 2713 |
| Problem visit on the same day, coded 99212 to 99215 with modifier 25 | Copay, coinsurance or deductible | A separately billed office visit can carry cost sharing under federal rules |
| Lab test ordered to check a symptom or follow a known condition | Coinsurance or deductible | Diagnostic tests aren’t preventive care |
| Any of the above from an out-of-network doctor or lab | Your plan’s out-of-network share | Plans may charge for preventive care outside the network if an in-network option exists |
Modifier 25 is the code that tells your insurer the doctor did a separate, significant piece of work that day. Billing guidance for the preventive codes says a minor problem the doctor handles in passing shouldn’t be billed this way.
How a five-minute talk cost $67
The clearest example comes from KFF Health News, which reported the case in October 2023. Christine Rogers, 60, of Wake Forest, North Carolina, filled out a depression questionnaire at her yearly physical. She mentioned her mother’s recent death, and her doctor talked with her about it for about 5 minutes.
The total bill came to $487, with $331 for the wellness visit and $156 for a second office visit billed at 20 to 29 minutes, and her share was $67.07.
Sabrina Corlette, a research professor at Georgetown University’s Center on Health Insurance Reforms, noted that depression screening “is now a recommended part of the annual physical” and that patients shouldn’t pay extra for a doctor reading the answers.
Once KFF Health News asked about the bill, Cigna said the wellness visit “was initially billed incorrectly with two separate visit codes,” and WakeMed refunded the $67.07.
A January 2024 KFF Health News story found the same pattern elsewhere. Peter Opaskar, 46, in Texas, mentioned digestive trouble at his checkup and got a bill for $111.81.
What turns $0 into a bill
Raising a new symptom changes the bill the most. If your doctor examines a new problem, orders tests for it or changes a medicine, that work can show up as the second visit in the table.
That doesn’t mean you should keep quiet about a health problem. It means you can ask, before the visit, whether the office will book a problem visit on the same day and what your plan charges for one. You can also ask to book the new problem as its own appointment.
Ordered labs are the next thing to watch. A lab drawn for a symptom, or to keep watch on a condition you already have, goes through your deductible like any other test. The lab may also send its own bill, and that lab has to be in your network for the $0 rate to apply.
Being new to a practice can matter as well. In the same January 2024 story, Kevin Lin of Virginia had no complaints at all and still got a $132.29 bill for a “new patient visit” on top of his checkup.
Grandfathered plans and Medicare
Two kinds of coverage don’t follow the $0 rule the way most private plans do.
A grandfathered plan is one that existed on March 23, 2010, the day the Affordable Care Act became law, and hasn’t changed much since. It doesn’t have to cover preventive care at no cost. Your plan materials have to say if it’s grandfathered.
Medicare is the other one. Original Medicare, meaning Parts A and B, doesn’t cover a routine physical exam at all.
It covers a “Welcome to Medicare” preventive visit within your first 12 months of Part B, then a yearly wellness visit, which Medicare.gov describes as a conversation to build a prevention plan. You pay nothing for those if your doctor accepts Medicare’s approved amount as full payment, though you can owe coinsurance and the Part B deductible for extra tests done the same day.
What isn’t worth paying for
A physical from an out-of-network doctor is hard to justify when the same visit costs $0 inside your network. Federal rules let your plan charge you for it, or skip it entirely, as long as an in-network doctor was available.
A bill that splits one conversation into two visits isn’t worth paying without a call, either. Ask the office for an itemized bill with the codes. If you see a 99212 to 99215 line with modifier 25 and you don’t remember raising anything new, ask the office and your insurer to review the coding. The Rogers bill was fixed that way.
What should I ask when I call?
Start with the network. Check that both the doctor and the lab the office uses are in your plan’s network, then ask for a list of the lab tests they plan to draw. Call the number on your insurance card to find out which of those tests your plan treats as preventive.
Then ask how the office handles a new problem raised during a checkup. You can say, “I’m booking my yearly preventive visit. If I bring up a new problem, will you bill it as a second visit that day, and if so, can we book it separately?”