Maintaining good health is essential. Unfortunately, it’s not an easy thing to do, especially if you’re uninsured. That’s because the cost of primary care without insurance varies based on several factors.
A simple primary care visit should cost you around $171 in major U.S cities. But you might pay $600 or more because additional tests or prescriptions incur separate charges.
So, just how much does primary care cost without insurance? What additional fees should you expect? Are there ways to save money and still get the care you need?
Let’s explore these questions and more below.
What Is Primary Care?
Before we discuss the cost of primary care without insurance, let’s define what primary care is and what it entails. Knowing this information will help you understand why healthcare without insurance can be costly.
Primary care is a form of care that gives individuals integrated, continuous, and coordinated support for their health and well-being.
It’s not one type of medical treatment, but an umbrella term that includes different kinds of health care such as:
- Preventative care like routine physical exams, screenings, and check-ups
- Treatment of minor injuries or illnesses
- Prescribing medications and
- Managing acute or chronic health conditions
Usually, primary care providers, commonly referred to as primary care physicians (PCPs), act as your point of entry into the healthcare system.
They are your first contact when you’re feeling sick and are often the ones who coordinate other specialist care you may require.
Different primary care physicians charge different amounts for their services.
What Does Primary Care Cost?
Most primary care doctors charge between $70 and $300. The amount averages $171. But this largely depends on your level of health concern and the type of service you seek, among other factors.
A minor health problem falls under a level 1 health concern since it might require simple treatment. Seeing a PCP with such a concern might cost you around $68.
If your medical issue is more complex, requiring comprehensive care, it falls under a level 5 health concern. You could pay approximately $230 for an office visit with such a problem.
It’s critical to note that office visits for various health problems come with specific services. And if you get any additional service not included in the office visit, you’re likely to pay more.
Say you saw your PCP for nutrition advice. That’s a level 1 health concern that costs roughly $68.
However, you could also get age-specific screening tests during the visit. In this case, you’ll pay more depending on the costs of the tests.
Each test or additional service comes with its cost, as indicated below.
Additional Costs Of Primary Care Visits
Several services can add to a primary care doctor’s base rate per visit. Some of the most common services that could see you incurring additional costs when getting primary care include:
- Blood count lab test – the fee of a blood count up to $620.
- Chest X-ray – simple chest X-rays may cost up to $200
- Flu test – costs $45 on average
- A pap smear – may cost up to $125
- Fetal ultrasound – cost up to $480
- Childhood immunizations – may cost $650 on average
** Prices of the above with insurance: Free or much lower than stated above.
These are just a few examples of the additional services you might need. There are more depending on your specific health needs at a particular time.
You could also require more than one test at a time, increasing your medical expenses further.
Let’s say you went to see your PCP with a level 5 health concern. Then the physician ordered a blood count lab test and a chest X-ray.
You’ll most likely pay somewhere between $474 and $1054 without insurance. That is the physician’s flat rate (appx. 234) + blood count test cost ($140 to $620) + chest x-ray cost ($100 – $200).
Most people hesitate to get primary care because of these additional costs. However, you can avoid these add-on fees by getting insurance.
Primary Care Cost With Insurance
Health insurance gives you peace of mind when getting primary care by reducing the total cost significantly.
You might pay between $25 and $50 as copayments based on your insurance plan. Most plans cover the additional services too. A good example is the affordable care act, which covers
- Blood pressure and cholesterol screening
- Depression screening
- STI screening, among others.
5 Factors That Affect The Cost Of Primary Care
The top five things that affect the cost of primary care include the type of service, type of visit, appointment length, location, and insurance.
It’s advisable to pay close attention to these factors before you visit your primary care physician. So you can know what to expect when getting health care without insurance.
Type Of Service
You can tell that the type of service you require affects the overall cost of primary care from the price estimates we mentioned earlier.
What you cannot tell straight away, however, is the type of additional service you might need during each visit. Most add-on services are a mandatory requirement for you to get the best medical care.
If you want to estimate the cost of care for your situation, find out whether there are any additional tests you’ll need beforehand.
You can prepare for all additional costs this way and avoid the financial stress that comes with surprise bills.
Type Of Visit Or Appointment
There are different types of visits or appointments. Most physicians charge various amounts for each visit:
- First visit for new patients. The first consultation visit might be the most expensive compared to any other. This is because such visits often call for several diagnostic tests as the doctor assesses your health and determines the best care for you.
- Follow-up. Follow-up sessions, if necessary, might cost less than the first visit.
- Non-urgent problem visit. Usually, these visits cover level 1 health concerns and might cost $68 or less.
- Urgent or same-day appointments. Urgent appointments cost more than a doctor’s standard rate since the physician might have to go out of their way to accommodate you.
- Annual Visits. Annual visits take place every year and are often well-known medical checkups. You could get an annual wellness or physical exam to prevent common health problems.
Generally, the standard wellness exam is cheaper than a physical exam since they don’t include many tests (if any). The entire visit might cost between $75 and $250.
On the other hand, physical exams are more extensive than wellness exams. They include several physical tests like vital signs checks, and charges start from $299 in most states.
- Shared Medical Appointments. Shared appointments often occur for health education purposes. They may be a combination of group and individual care and can cost the same as one-on-one personal care or less.
Face-to-face physician-patient time is a price-controlling factor for medical care visits within the health industry. Every health visit has different components and could last a given time.
The American Academy of Family Physicians (AAFP) estimates how long various one-on-one physician-patient visits last and classifies them into different codes.
The association then uses these codes to regulate the amount physicians can charge patients for several visits.
For example, code 99213 stands for a sick visit and requires the doctor to evaluate and manage an illness’s symptoms. The AAFP estimates such a visit to last appx. 15 minutes. This visit might cost you less than another that lasts 25, 30, or 40 minutes.
Overall, the longer the doctor’s visit, and the more services you require, the more costly it will be.
Primary care costs vary from state to state, city to city, and clinic to clinic.
You could pay roughly $190 to get primary care in Los Angeles, CA, and less (about $149) for similar services in New York.
The cost may be lower (as little as $40) in several cities within the same geographic area. You could also pay a small fee or nothing, depending on the physician’s location.
Specifically, seeing a PCP at a community health clinic in NYC is free. It’s different from seeing the same physician in a hospital setting, which might cost you over $149.
Different insurance plans have policies that influence the cost of primary care differently.
However, most plans pay for medical care with preventative benefits fully. This means that you can get several primary care services without making copayments or coinsurance.
An example of such insurance coverage is Medicare. It covers an annual wellness visit, where you can access several preventive and screening services. But you must have had Medicare plan B for a year or longer to qualify for this.
If you’re looking for more comprehensive coverage, consider the part C Medicare Advantage option from a private insurance company.
It’ll cover hospital care, primary care physician fees (including various tests and procedures), and prescription drugs at an affordable monthly premium.
There are many other insurance options you could consider, even if you’re unemployed. At Enhance Health, we specialize in finding the right health insurance plan for your needs and your budget.
How To Save Money On Primary Care Visits
Here are a few ways you can save money on primary care visits if you’re uninsured:
- Research. Look for the most affordable primary care doctor and location that matches your budget. It’s easy to know what different physicians charge for various tests. The hospital price transparency regulation requires all medical centers to make their charges public.
- Mention you’re uninsured and negotiate. Most PCPs adjust their charges when they learn their patients lack insurance. You can also negotiate for better prices before or after seeing the physician. The cost of primary care isn’t rock-solid.
- Request a payment plan to minimize upfront costs. Some physicians allow you to pay over a specific time. They split the final bill into several payments through various approaches, such as:
- Fee for service approach: You pay some percentage of the bill upfront. Then make small payments to finish paying what’s left over some time.
- Monthly payments: Often called direct care, this payment structure is best if you’ve established a long-term relationship with your physician. You pay fixed monthly payments to cover certain primary care specialties.
- Annual pricing: You pay for all services you’ve received throughout the year once.
4. Use prescription saving cards. These come in handy, especially if you need medications to manage various conditions and need to refill often.
Your health is your greatest asset. Maintain it properly without draining your finances by following all the tips we’ve shared in this article and getting insurance.
Insurance makes healthcare affordable for everyone. It’s the best way you can control primary care costs.
Visit Enhance Health to find affordable healthcare plans. We are always here to help you get the perfect plan within your means.