Well-woman exam

Each year, the Affordable Care Act entitles all women to one free well-woman exam each year. The cost is covered-in-full as a preventive benefit, which means it's free even if you haven't met your plan's deductible. Here’s how these annual exams work, and how you can get the most out of them.

What is a well-woman exam?

The goal of the well-woman exam is preventive care—helping you identify and deal with health problems as early as possible. Set a reminder to schedule yours once a year when you're feeling fine.

A typical annual exam incudes:

• Documenting your health habits and reviewing your family history: When you arrive for your well-woman appointment, your doctor or nurse practitioner will ask some questions about your overall health in order to identify risk factors. These questions may cover topics like your medical and obstetrical history, family health history, medication history, sexual health, reproductive health, mental health, eating habits, physical activity, and drug use. Medical professionals are required to keep a patient’s personal health information private, so you can discuss these and any other health concerns to the degree that you feel comfortable.
• Providing a physical exam, ordering tests and other services: This generally includes specific exams, lab tests, and sometimes immunizations, all in order to prevent diseases or catch them early, when they may be easier to treat.
• Helping you set health goals: Finally, you and your doctor or nurse practitioner have the opportunity to talk about the next steps for helping you stay healthy. This may involve education and conversation around making informed health decisions about your diet, medication, exercise, stress management, and more. Together, you can also review and decide which screenings or follow-up services might be right for you.

What's covered during my well-woman exam?

In order for your well-woman exam to be free, it must take place with a doctor or nurse practitioner who accepts your insurance. Some women choose OB-GYNs, while others opt for certain specialists, primary care doctors(aka PCPs (opens in new tab)), or nurse practitioners. Keep in mind, if the provider isn't an OB-GYN or a PCP, the service will not be covered-in-full. The key is to find a provider in your network with whom you feel comfortable. Ideally, this should be someone you’d like to continue to see, so you can together identify a wellness baseline for you and track changes over time.

Once at your appointment, screening tests are among the most important things you can do for your health, so take advantage of preventive screenings recommended according to your age and risk factors.

You’re probably familiar with most of these core services (a lot of them take place during your annual OB-GYN exam), all of which are typically covered by Marketplace plans:

• Measuring your height and weight, and sometimes calculating your body mass index (BMI).
• Checking your blood pressure.
• Taking your temperature.
• Doing a breast exam (feeling your breasts and under your arms for lumps or other changes).
• Doing a Pap smear and pelvic exam. This is the one you're probably most familiar with from your annual gynecological exams. Based on your age, your provider will discuss with you how often you should be screened.

You and your provider can also decide on some of these additional services. Marketplace (opens in new tab) plans typically cover the below in full if coded as preventive care by the provider. If the visit becomes diagnostic (opens in new tab) in nature, these services will no longer be covered-in-full (even if the visit was intended to be preventive):

• Certain types of cancer screenings
• HPV screening (human papillomavirus, which can lead to cervical cancer)
• HIV and other sexually transmitted diseases (STDs) screening
• High blood pressure and cholesterol screening
• Diabetes screening
• Osteoporosis (weak bones) screening
• Depression screening
• Domestic partner abuse screening
• Colon cancer screening (if you’re over 50)
• Mammograms (every 1-2 years if you’re over 40)
• Providing immunization for Hepatitis A and/or B; Herpes Zoster; HPV; influenza; tetanus, diphtheria, and pertussis; measles, mumps, and rubella; and more.

Sometimes, your provider will want to do further tests that aren’t covered-in-full (opens in new tab) with your well-woman exam. For example, if you are a diabetic, your doctor may want to order a blood test to check on your diabetes. Because you already know you have diabetes, the test isn’t considered preventive, and would therefore be diagnostic and subject to the cost-sharing of your plan. If you’re concerned about costs, or just want to keep track and avoid surprises, you can ask your provider at the beginning of the visit to specify which tests, if any, are diagnostic.

How can I optimize my visit?

Well-woman exams can offer an incredible opportunity to get information, set goals, and plan ahead. To make sure you don’t forget something important when you’re on the spot, write down your medications and doses, major medical events including surgeries and vaccines (opens in new tab), and any medical conditions and concerns ahead of time.

Likewise, because your family’s health history can help your provider determine your risk factors, write down which close relatives have had cancer, heart disease, and other serious health problems beforehand as well.

Finally, bring questions and be ready to take notes. Much of the value of these visits can come from gathering knowledge from your doctor or nurse, and talking about the next steps that you can take to stay healthy and meet your personal wellness goals.

For some suggestions on what to ask and how to prepare, check out our post on questions to ask during your well-woman visit (opens in new tab) and 7 ways to make the most out of your next OB-GYN appointment (opens in new tab).