Questions
Is a Well-Woman Exam Covered by Insurance?
Yes, under the Affordable Care Act, most insurance plans cover a well-woman exam annually with no copay or deductible when you visit an in-network provider like a certified nurse-midwife. This includes preventive services like a pelvic exam, breast exam, and Pap smear. Always confirm with your specific plan.
Is a Well-Woman Exam Covered by Insurance?
Yes, for most people with health insurance, a well-woman exam is covered at no cost to you. Under the Affordable Care Act (ACA), preventive services like well-woman exams and screenings are covered without a copay or deductible when you see an in-network provider. This includes your annual pelvic exam, breast exam, and Pap smear.
However, coverage can vary by plan. Some insurance companies may require you to use a specific provider or may not cover additional tests or services during the same visit. We recommend calling your insurance company or our office to verify your coverage. At The Midwife and More, we accept most major insurance plans and can help you understand what's included.
If you have questions about your specific plan, give us a call at 877-537-3240. We serve patients from Thousand Oaks, Westlake Village, Camarillo, Fillmore, Calabasas, Agoura Hills, and surrounding areas.
What's Included in a Well-Woman Exam?
A well-woman exam is a comprehensive preventive visit focused on your reproductive and overall health. Here's what you can typically expect:
- Pelvic exam – Your provider checks the health of your vagina, cervix, uterus, and ovaries.
- Pap smear – Screens for cervical cancer; usually done every 3–5 years depending on age and history.
- Breast exam – A clinical check for lumps or changes in breast tissue.
- Health history review – Discussion of your menstrual cycle, sexual health, contraception, and any concerns.
- Preventive counseling – Advice on nutrition, exercise, stress management, and lifestyle choices.
- Vaccinations and screenings – May include blood pressure check, cholesterol screening, and immunizations as needed.
Medicare and Medicaid Coverage for Well-Woman Exams
| Insurance Type | Coverage Details | Frequency | What's Not Covered |
|---|---|---|---|
| Medicare Part B | Covers a well-woman exam (including pelvic exam, breast exam, and Pap smear) at no cost if your provider accepts assignment. | Every 12 months | Additional tests or services not deemed preventive; may require coinsurance. |
| Medicaid | Coverage varies by state; most states cover annual well-woman exams as preventive care. | Typically annually | Some states may limit coverage to certain providers or require prior authorization. |
| TRICARE | Covers well-woman exams for active duty and retired military members and their families. | Annually | Services not considered preventive may have cost-sharing. |
Always check with your specific plan. For Medicare, the exam is covered under the Medicare Part B preventive benefit. For Medicaid, benefits differ by state; contact your local office for details. If you have questions, call our team at 877-537-3240.
Well-Woman Exam vs. Pap Smear vs. Annual Physical
| Service | Focus | What It Includes | Frequency |
|---|---|---|---|
| Well-woman exam | Reproductive and women's health | Pelvic exam, breast exam, Pap smear, health counseling | Annually |
| Pap smear | Cervical cancer screening | Collection of cervical cells; may be part of well-woman exam | Every 3–5 years |
| Annual physical | General health | Vital signs, blood work, overall health assessment | Annually |
A well-woman exam is not the same as an annual physical. The well-woman exam focuses on reproductive health, while a physical covers overall wellness. Many women have both, but they are separate visits.
Directions to our midwife near me from Newbury Park, California
Start at Newbury Park, California and head to The Midwife and More at 5115 Clareton Drive, suite #100, Agoura Hills, CA 91301.
Age Guidelines for Well-Woman Exams
| Age Range | Recommendation | Notes |
|---|---|---|
| 13–20 | Start at age 21 or earlier if sexually active | Discuss contraception, STI screening, and menstrual health. |
| 21–29 | Annual well-woman exam; Pap smear every 3 years | Pelvic exam may be done annually. |
| 30–65 | Annual well-woman exam; Pap smear every 3–5 years (with HPV co-testing) | Continue preventive care and screenings. |
| 65+ | Discuss with your provider; may continue as needed | Pelvic exams may still be recommended for symptoms or history. |
According to the American College of Obstetricians and Gynecologists (ACOG), women should start well-woman exams at age 21. After age 65, you may not need a Pap smear if you've had normal results, but a well-woman exam can still be valuable for overall health. Always follow your provider's advice.
Schedule Your Well-Woman Exam in Agoura Hills
Ready to book your annual well-woman exam? We make it easy. Here's how:
- Call us – Dial 877-537-3240 to speak with our team. We accept most major insurance plans and can verify your coverage.
- Book online – Use our online scheduling tool to pick a time that works for you. We offer appointments Monday through Friday, 9 AM to 5 PM, and after hours by appointment.
- Visit our clinic – We're located at 5115 Clareton Drive, suite #100, Agoura Hills, CA 91301. We serve Thousand Oaks, Westlake, Camarillo, Fillmore, Calabasas, and surrounding areas.
- Prepare for your visit – Bring your insurance card, a list of any medications, and any questions you have. No special preparation is needed for a well-woman exam.
We're here to support your health every step of the way. Schedule your well-woman exam today.
Well-Woman Exam Cost Without Insurance
| Factor | Why It Matters | Typical Range |
|---|---|---|
| Provider type | Certified nurse-midwives and nurse practitioners often have lower fees than OB/GYNs. | Varies |
| Location | Costs differ by region and clinic. | Varies |
| Services included | A basic exam costs less than one with additional tests like blood work or a Pap smear. | Varies |
| Insurance discount | Some clinics offer cash-pay discounts or sliding-scale fees. | Ask for a quote |
Without insurance, the cost of a well-woman exam can vary widely. We recommend calling our office at 877-537-3240 for a personalized quote. We're committed to transparent pricing and can discuss payment options.
For details on services and visits, see the main page about midwife near me.
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Frequently asked questions
Does a well-woman visit include a pap?
Yes, a well-woman exam typically includes a Pap smear if you are due for one based on your age and history. The Pap smear screens for cervical cancer and is part of the preventive services covered by most insurance plans.
Should a 75 year old woman see a gynecologist?
It depends on her health history and symptoms. Many women over 75 may still benefit from a well-woman exam, especially if they have new symptoms or a history of gynecologic issues. The American College of Obstetricians and Gynecologists recommends discussing continued care with your provider.
How much is it out of pocket to see a gynecologist?
The out-of-pocket cost to see a gynecologist varies widely depending on location, provider, and services. Without insurance, a well-woman exam can range from $100 to $300 or more. We recommend calling our office for a quote.
How often does Medicare pay for a well-woman exam?
Medicare Part B covers a well-woman exam (including a pelvic exam, breast exam, and Pap smear) once every 12 months, as long as your provider accepts Medicare assignment. There is no cost for the exam itself, but additional tests may have coinsurance.
At what age can a woman stop having pelvic exams?
There is no set age to stop pelvic exams. The decision is based on your health history, symptoms, and risk factors. Many women continue pelvic exams into their 70s if they are sexually active or have concerns. Talk to your provider about what's right for you.
Also asked as
- Does insurance cover annual well-woman exam?
- Is a well-woman visit free with insurance?
- What is covered in a well-woman exam insurance?