Is a Physical Exam Required for Health Insurance?
Just the Essentials…
- Most plans do not require a preliminary physical exam, though many offer a post-enrollment wellness check as a preventive service.
- Under the Affordable Care Act (ACA), insurers cannot deny you coverage based on health conditions, nor can they charge higher premiums.
- Non-ACA compliant plans, like short-term insurance, may require a preliminary screening.
Do Modern Health Insurance Plans Require a Physical?
It’s no secret that insurance is a game of risk management, which is why many insurance companies look at various factors when determining your insurance rates and premiums. Your car insurance, for instance, goes up if you have previous claims, a record of traffic infractions, or if you live in an area with a high rate of accidents.
Health insurance used to operate the same way: you needed to undergo a physical to determine your level of health, and your premiums could be affected by pre-existing conditions. That is, assuming they would insure you in the first place. This led to many of America’s sickest citizens’ inability to afford insurance, leading to mountains of medical debt. Thanks to the Affordable Care Act (ACA), however, this is no longer the case.
Most health insurance plans do not require a physical exam before enrollment, nor can they deny you coverage due to prior health conditions. They also cannot change your premiums due to health conditions. This applies to both Marketplace plans and ones offered through employers. However, some exceptions exist. Short-term plans, international health insurance, and other individual plans purchased outside of the Marketplace are not subject to the ACA and may require a pre-policy health screening.
ACA Plans: Insurance for All?
While it’s commonly referred to as the Affordable Care Act, the ACA is titled the Patient Protection and Affordable Care Act. A primary goal of the act is to protect consumers from unfair practices, like frivolous cancellations or premium increases.
In the past, if any condition was identified during your health screening, an insurer could deny you coverage or charge you higher premiums. Now, when presented a plan on the Marketplace or a state insurance exchange, the price you see is the price you pay. Due to prior health conditions, you cannot be denied, nor are the premiums affected by your medical history. They’re simply a function of the plan’s coverage area, network, and metal category.
You may, however, be asked to undergo a physical exam after enrolling. This physical exam does not affect your premiums: it is a preventive service mandated under the ACA and comes at no cost to you. It’s an excellent chance to meet your primary care physician and determine the future trajectory of your care.
If you are applying for a plan not covered by the ACA, you are not subject to the same protections. These plans have become increasingly rare since the ACA first came into effect. Despite this, there are rare cases where you may purchase a non-ACA plan.
Short-Term Health Care
Short-term plans are meant to be a temporary measure: a way to purchase insurance outside of the typical enrollment periods. They’re great if you need insurance right now but have significant disadvantages compared to an ACA-compliant plan. A 2020 study by the Commonwealth Fund looked at 412 plans across five states: all of them denied enrollment based on health status and refused to cover pre-existing conditions. These plans may require a physical before enrollment, which may affect your eligibility.
Some insurers offer coverage for people traveling or living overseas. These plans function very similarly to short-term plans because they are short-term plans: coverage meant to last less than a year. The requirements vary depending on the plan, and short-term travel coverage will likely not require a physical. However, if you plan on living overseas for several months, your insurer may require pre-screening.
In addition, plans based in foreign countries may still require a preliminary physical. If you have dual citizenship and your primary insurer is overseas, you may be subject to different rules.
Finding the Right Plan
While the ACA guarantees coverage, you still need to find the right plan. Our licensed insurance agents can help. Call us at (800) 318-9984 to talk to a licensed insurance agent, or enter your zip code to begin your search today.