Oscar | The ultimate guide to acing your annual physical | hioscar Blog | Oscar
The ultimate guide to acing your annual physical
An annual physical helps establish a baseline so you and your doctor manage risk factors and catch issues early.
Plan Basics Oscar Health Insurance
6 min read
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An annual physical is a preventative (opens in new tab) exam you get once a year that’s free of charge with your health insurance plan. It’s important to visit your primary care provider (opens in new tab) (PCP) routinely in order to establish a baseline on your health. The Mayo Clinic (opens in new tab) recommends a yearly physical for men and women over age 50; while women under age 50 should have a physical every 2 to 3 years, and men under the age of 50 should do so every 3 to 5 years.
What happens during an annual physical?
During your physical, your PCP will conduct a physical examination, take your vitals such as blood pressure, check your weight, listen to your heart and lungs, and examine your skin for any abnormalities.They’ll talk with you about your personal and family health history, and may suggest additional diagnostic testing (opens in new tab) such as an EKG or stress test. Additionally, your doctor will draw blood to test, and give you any vaccinations (opens in new tab) you need to stay healthy throughout the year. Providers generally keep vaccinations in their office, but on occasion, they’ll need to write you a prescription (opens in new tab).
It’s important to have a conversation with your doctor about the tests they are ordering and the lab they work with. Keep in mind that a followup appointment may be required to receive your lab results or certain vaccinations. Check in with your doctor’s office about their process for sharing lab results and when you can expect them. In order for your blood work to be covered, it must be sent to a lab in Oscar’s network.
Preventive blood tests that are done during your annual physical are $0. Diagnostic tests, and EKGs are common and may be standard procedure for your provider, they aren't part of the standard annual physical exam as defined by the Affordable Care Act (opens in new tab), so they're subject to cost sharing, which means you could end up getting a bill. However, if your doctor orders additional diagnostic testing (opens in new tab) to detect issues, for example, with your thyroid or vitamin levels, those tests are subject to cost sharing (opens in new tab), so you might be on the hook for all or part of the cost depending on your plan.
You and your doctor will also discuss your general health and any other symptoms or changes you’ve noticed in the past year. You may need to see a specialist to receive additional care. Depending on your age, your physician might also recommend other preventive procedures such as a colonoscopy, mammogram or prostate exam. Women may opt for a well-woman exam (opens in new tab), an annual exam performed by an OB-GYN that’s also free of charge, instead of an annual physical.
How should I prepare for my annual physical?
Before your appointment, we suggest:
Bring a list of your medications
Brush up on your family history
Be prepared to answer questions about your health, including sleep, sexual activity and alcohol intake.
Write down any symptoms you want to discuss with your doctor
If you’re switching doctors, it’s a good idea to contact your former provider and have their office transfer your records to your new doctor so they can have a better sense of your medical history.
Remember, your physical health is equally as important as your mental health (opens in new tab). Use this time with your doctor to discuss changes in mental health, or ask for recommendations for a mental health provider like a therapist or psychiatrist.
What should men expect during their physical?
Men under the age of 50 can expect additional screenings for testicular cancer, discussions on alcohol and substance abuse, stress levels, cholesterol and diabetes screenings. For men over the age of 50, your physical will include all of the above, as well as discussions with your PCP on screenings for prostate, colorectal, and lung cancer with a specialist.
What should women expect during their physical?
Similar to men, women under the age of 50 can expect to have their cholesterol levels checked, a diabetes screening, plus a discussion of common cancer screenings that include breast, cervical and colorectal screenings. The average age for menopause in the US is 51 (opens in new tab). With menopause, comes a higher risk of chronic medical conditions such as cardiovascular disease, osteoporosis, and weight gain. It’s important to speak openly with your PCP about changes in your body as you navigate this next phase in your health.
Finding a doctor with Oscar
Members need to see a doctor in Oscar's network (opens in new tab) when you get your physical. Search here (opens in new tab) or in the Oscar app to confirm your doctor takes your insurance plan, or to find someone new. Once you’ve selected a doctor, schedule your appointment as soon as possible – physical appointment times can fill up fast. When you schedule your appointment, let them know you're coming in for an annual physical and confirm that your doctor accepts Oscar to avoid billing issues later on.
Your doctor’s office will require your Oscar ID Number and personal information for billing purposes, so be sure to have your ID card handy when you check in. Don’t worry if you’ve misplaced it – you can access your virtual ID card in the Oscar App (opens in new tab) or by logging into your account at hioscar.com.
Common surprises
Doctors will often conduct additional diagnostic testing or services during an annual physical based on the information you give them about your health during your exam. These types of services are used to diagnose or treat a medical condition and are not free. They are covered (opens in new tab), but the cost sharing terms of your plan kick in. This means that if you receive diagnostic services and your plan has a deductible (opens in new tab) or copays, you'll have to pay for those services. Any payment you make will count toward your deductible as long as you're seeing a doctor in the Oscar network.
When to talk to your Care team
If you need help finding a doctor or want to review what’s covered by your plan, just call your Oscar Care team. They can help you compile a list of questions to ask your doctor and avoid common mistakes. Give us a call at 855-672-2755, or message us in the Oscar app (opens in new tab).
For 2023, Oscar Primary Care is available in TX (excluding Secure plans), NY (excluding Standard Silver, Standard Bronze, and Secure plans), FL, Palm Beach, Miami Dade, and Broward (excluding HSA and Secure plans), AZ (excluding HSA and Secure plans), GA (excluding HSA and Secure plans) Oscar Primary Care providers are employed by Oscar Medical Group, not Oscar Insurance Company or its insurance plan affiliates. Oscar Primary Care is only available to members 18 years of age and older. Prescriptions, visits and services may be limited at the provider's discretion and Oscar Primary Care is not intended to be used in conjunction with another primary care consultation. Oscar Care in-person visits in conjunction with your virtual visit may have a copayment. Due to medical licensing laws, you must be in your home state at the time of your virtual visit.
