Quanto Custa Exame físico anual?
An annual physical exam is a comprehensive health checkup that includes vital signs measurement, physical examination, health history review, and age-appropriate screenings. Under the Affordable Care Act, preventive visits are covered at no cost to insured patients.
Sem Seguro
$250
Com Seguro
$0
Medicare
$0
Média Nacional
$83
Visão geral
An annual physical exam (also called a preventive visit, wellness visit, or well-adult check-up) is a structured primary-care visit focused on health maintenance, risk-factor counseling, age-appropriate screenings, immunizations, and review of chronic conditions. Under the Affordable Care Act, most commercial plans must cover an annual preventive visit with no cost-sharing when delivered by an in-network provider, and Medicare Part B covers an annual 'Wellness Visit' with no coinsurance. Visit length varies from 20 to 60 minutes depending on complexity. Critically, the cost-sharing protection applies only to the preventive components of the visit; if the visit shifts into discussion or management of a specific medical problem (an acute illness, medication change, or chronic-condition management) the provider may additionally bill a problem-focused E/M code that triggers cost-sharing. Understanding this boundary helps patients avoid unexpected bills after what they thought was a 'free' physical.
O que afeta o custo
- Whether the visit is coded as purely preventive vs mixed preventive-and-problem (a 'split' visit with two CPT codes).
- Provider type: physician vs nurse practitioner/PA — pricing is often similar under insurance but may differ self-pay.
- Additional screenings bundled in: a preventive visit does not inherently include lab work, EKG, spirometry, etc. These are billed separately and may or may not be covered as preventive.
- Site of service: hospital-owned primary care may add a facility fee that independent practices do not.
- Geographic market: primary-care pricing varies substantially between low and high cost-of-living areas.
- Length and complexity of the visit; longer preventive visits with comprehensive counseling are sometimes coded at a higher level.
Como Economizar
- Before the visit, clarify with the provider's office that you are booking a preventive annual exam, not a problem-focused visit.
- If you want to also discuss a specific issue, ask how it will be billed — some patients choose to schedule a second visit to preserve the no-cost-sharing preventive benefit.
- Confirm the clinic is in-network; out-of-network preventive care is not covered at no cost.
- For lab work ordered during the visit, ask whether it qualifies as preventive (USPSTF-recommended screening tests typically do) or diagnostic.
- If uninsured, ask whether the practice offers a direct-primary-care membership — flat monthly fees can be cost-effective.
- Take advantage of Medicare's Annual Wellness Visit (AWV) — it is a structured preventive benefit with no coinsurance, separate from problem-focused visits.
Notas sobre seguro e cobertura
Most ACA-compliant commercial plans cover one preventive visit per 12 months at no cost-sharing when the visit is billed with preventive CPT codes (99381–99397). Medicare Part B covers an annual Wellness Visit and a separate Initial Preventive Physical Examination (IPPE, or 'Welcome to Medicare' visit) at no cost-sharing. Medicaid coverage varies by state but is typically comprehensive for children (EPSDT) and generally available for adults. When the provider documents and bills both a preventive code and a problem-focused E/M code for the same visit, the problem-focused portion is subject to your deductible and coinsurance; some plans waive a modest amount of cost-sharing in this case but most do not.
Data sources for this page
Cost figures on this page are compiled from the following sources, triangulated per the rules in our methodology:
- CMS Medicare Provider Utilization and Payment Data 2025 — primary CMS reference used as the Medicare-rate anchor.
- Hospital Price Transparency machine-readable files (HPT MRFs) from a sample of major hospitals in each state, per the federal Hospital Price Transparency rule.
- Transparency in Coverage payer in-network rate files for commercial-rate cross-validation.
- State All-Payer Claims Database (APCD) summaries where published (Colorado, New Hampshire, Massachusetts, Minnesota, Maine, Utah, Vermont, Rhode Island, Washington, Oregon).
Last reviewed 2026-04-16. See editorial standards for our fact-checking process and correction policy.
Range: $182 to $345 · 50 states shown
Custo por Estado
| Estado | Sem Seguro | Com Seguro | Medicare |
|---|---|---|---|
| Mississippi | $182 | $0 | $0 |
| Arkansas | $188 | $0 | $0 |
| West Virginia | $188 | $0 | $0 |
| Alabama | $195 | $0 | $0 |
| Oklahoma | $195 | $0 | $0 |
| Kentucky | $212 | $0 | $0 |
| Louisiana | $215 | $0 | $0 |
| Iowa | $220 | $0 | $0 |
| New Mexico | $220 | $0 | $0 |
| South Carolina | $220 | $0 | $0 |
| South Dakota | $220 | $0 | $0 |
| Kansas | $222 | $0 | $0 |
| North Dakota | $222 | $0 | $0 |
| Idaho | $225 | $0 | $0 |
| Nebraska | $225 | $0 | $0 |
| Tennessee | $225 | $0 | $0 |
| Indiana | $232 | $0 | $0 |
| Missouri | $232 | $0 | $0 |
| Utah | $232 | $0 | $0 |
| Wyoming | $232 | $0 | $0 |
| Georgia | $235 | $0 | $0 |
| North Carolina | $235 | $0 | $0 |
| Michigan | $238 | $0 | $0 |
| Montana | $238 | $0 | $0 |
| Arizona | $245 | $0 | $0 |
| Ohio | $245 | $0 | $0 |
| Wisconsin | $245 | $0 | $0 |
| Maine | $248 | $0 | $0 |
| Texas | $248 | $0 | $0 |
| Florida | $252 | $0 | $0 |
| Minnesota | $252 | $0 | $0 |
| Illinois | $258 | $0 | $0 |
| Pennsylvania | $258 | $0 | $0 |
| Delaware | $260 | $0 | $0 |
| Nevada | $260 | $0 | $0 |
| Vermont | $260 | $0 | $0 |
| Virginia | $260 | $0 | $0 |
| Colorado | $265 | $0 | $0 |
| New Hampshire | $265 | $0 | $0 |
| Oregon | $265 | $0 | $0 |
| Maryland | $275 | $0 | $0 |
| Rhode Island | $278 | $0 | $0 |
| Washington | $278 | $0 | $0 |
| Connecticut | $300 | $0 | $0 |
| New Jersey | $300 | $0 | $0 |
| California | $328 | $0 | $0 |
| Massachusetts | $332 | $0 | $0 |
| Alaska | $338 | $0 | $0 |
| New York | $338 | $0 | $0 |
| Hawaii | $345 | $0 | $0 |
Perguntas Frequentes
Quanto custa exame físico anual sem seguro?
O custo médio de exame físico anual sem seguro nos Estados Unidos é $250. Os custos variam significativamente por estado.
O seguro cobre exame físico anual?
A maioria dos planos de seguro de saúde cobre exame físico anual quando medicamente necessário. Com seguro, o custo médio do próprio bolso é $0.
O Medicare cobre exame físico anual?
O Medicare Parte B geralmente cobre exame físico anual quando prescrito por um médico. O valor médio aprovado pelo Medicare é $0.
Revisado por Elena Bellini · Última revisão: 2026-04-16
Dados obtidos de CMS Medicare Provider Utilization and Payment Data 2025. Última atualização: 2026-03-01. Esta informação é apenas para fins educacionais e não constitui aconselhamento médico. Este site é apenas para fins informativos e não constitui aconselhamento médico. Consulte sempre um profissional de saúde qualificado.