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What Do Florida Health Insurance Plans Cover in Regard to Well Visits (Checkups)? Most Florida health insurance plans provide at least a minimal level of coverage for checkups or well exams. However, some are clearly more generous than others when it comes to preventative care. There are many factors that go into choosing a health insurance plan. I would not want you to base your decision solely on the richness of the preventative care benefit. You can easily end up with either an inferior company, or a plan that charges a lot more in premium and wipes out any savings you get from the better benefit. By the way, this is true for all benefits. You always want to weigh the extras you receive against the extra premium you pay. What Preventative Care Tests Are Covered? Preventative care might cover the following tests:
I hope you noticed that I used the phrase “might cover”, as not all plans provide the same coverage. Let me show you how crazy this can get. I am going to use four major carriers in this example. Keep in mind that these are Fortune 500 companies. Carrier A – This company will cover your routine physical after you have been on the plan for 90 days. They will pay for 80% of the physical (100% for mammogram) but will not cover any lab work until you meet the plan deductible. They cover a maximum of $300 for this benefit. Carrier B – This carrier will pay up to $200 for preventative care with no waiting period and will cover lab and x-rays. Carrier C – They will cover $500 of your checkup but will not pay anything until you meet the deductible. They are also very sneaky about hiding this fact. This is a useless benefit. Carrier D – Has unlimited coverage for well visits and will cover all the tests in the list above. It is the only company that will cover cardiac stress tests. All physicals must be conducted in a physician's office. You cannot check into the Mayo Clinic for your physical. You can see that there are wide variations as to what is covered in a physical and how much out of pocket expenses you will incur. You should note that even though one of the plans does not cover your lab fees for checkups, you are still entitled to the reduced, PPO rate. In most cases, this will be less than $100. If this plan saves you $50 a month in premium, you do not want to eliminate it from consideration. Will They Cover a Colonoscopy? The short answer is no, they will not. I have one plan that will cover this test every five years. However, the premiums are so much higher than everyone else, that it just does not pay. If you go to your physician and a colonoscopy is required as a diagnostic test as opposed to a routine test, then it will go towards your deductible. Bottom Line If you have concerns about what is covered and what is not, ask me. You are probably not surprised to hear that only a small percentage of people I talk to ever get a physical, and most of those are women. Men just sit around in denial until they have a heart attack. Remember, the preventative care benefit should not be the sole factor in deciding which plan to buy. Always look at the cost versus the benefit.
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