Insurance & Coverage

What’s free and what will I pay out of pocket for? All annual wellness exams are covered by most insurance plans at 100% under the preventative health benefit. This means as long as nothing “extra” is billed (ie: hurt knee, new rash, etc), you shouldn’t incur any out of pocket costs.

Labs Covered by Insurance: In addition to screening for high cholesterol, diabetes and prostate cancer (men 50 and older), a CBC and a CMP are covered labs as part of an adult annual wellness exam; these labs would not typically incur any out-of-pocket costs to your visit.

STI screening is often covered under the preventative care benefit; however, we cannot guarantee this.

Labs NOT Covered by Insurance: In asymptomatic individuals, the American Thyroid Association (ATA) recommends adults get their thyroid function tested every five years, starting at age 35; this screening would often be “covered” under the visit but billed with a balance applied towards your deductible.

Evidence doesn’t support the practice of routine vitamin d level screenings; however, our experiential evidence would say that 99% of individuals who live Montana and do NOT take a vitamin D supplement regularly are vitamin D deficient. We recommend screening annually for vitamin D deficiency, or at least every 3-5 years.

If you would like to screen for low testosterone, menopause, low B12 or iron, or any other deficiency/imbalance, we are happy to order whatever tests you would like through our LabCorp Catalog. We will do our best to “code” your visit so your insurance will “cover” these labs as an approved service; however, these costs will likely be billed and applied towards your deductible.

SCREENINGS FOR CANCER, OSTEOPOROSIS, AAA, etc: Your health care team will review and help tailor a list of recommended screenings based on your age, gender and risk factors; typically, when coded as a preventative service, these are also covered by most insurance plans in their entirety (mammograms, PAP smears, DEXA scans, colonoscopies, PSA levels, etc)

Medicaid covers the cost of most health care services including adult and child wellness exams, routine office visits, same day visits, most labs and behavioral health services.

For 2025, the Medicare Part B deductible is $257 per year. A Medicare deductible is the amount of money you must pay out of pocket for covered healthcare services before Medicare starts to pay its portion; essentially, it’s the initial cost you bear each year before your Medicare benefits kick in, after which you typically only pay a percentage (coinsurance) for covered services.

Once you meet your deductible, you usually pay a percentage (typically 20%) of the cost of covered services, with Medicare covering the rest.

Welcome to Medicare Visit: Scheduled at any time during your first 12 months on Medicare

What’s included?

A “Welcome to Medicare” visit includes a review of your medical and social history, recommendations for preventive services, including certain screenings, shots or vaccines (like flu, pneumococcal, and other recommended immunizations), a measurement of vital signs including height and weight, a simple vision test, screen for depression and review of your advanced directives.

What’s not included?

A “Welcome to Medicare” visit does not include routine blood work, lab tests, imaging, or a full physical exam.

As much as we understand how frustrating it may be to come in more than once a year, there isn’t enough time to everything in one visit.

Subsequent Annual Medicare Visits: FYI you don’t need to have had a “Welcome to Medicare” preventive visit to qualify for a yearly “Wellness” visit after age 65.

What is included in an annual Medicare Visit?

Routine measurements (like height, weight, and blood pressure), a review of your medical and family history, a review of your current prescriptions, personalized health advice, advanced care planning (ie: living will, POLST), a screening schedule (like a checklist) for appropriate preventive services.

What’s not included?

A subsequent Medicare annual wellness exam does not include a full physical exam, diagnosis or treatment of new medical conditions, prescription or adjustment of medications, lab tests like bloodwork or X-rays, or any procedures to address existing chronic illnesses; its primary purpose is to review your health risks and create a personalized prevention plan, not to diagnose or treat active health issues.

What do we recommend to maximize your benefits?

• Initial Welcome to Medicare Visit at age 65
• Annual Medicare Wellness exam after 65
• The standard of care for most chronic conditions (hypertension, high cholesterol, asthma, COPD, depression, anxiety, hypothyroidism, etc) requires office visits every 6 months; this allows us to take the best care of you.
• Phone call with provider to review lab and imaging results
• In most health care facilities, it’s typical for a medical assistant to relay lab findings to patients. This works well when the findings are straightforward and there are no concerns.
• However, after two office visits, you have most likely met your Medicare deductible. We recommend having a quick Telehealth or in-person visit with your provider to review your lab/imaging findings so we can answer your questions and discuss a plan of care moving forward.