Get Informed

Understanding your healthcare coverage and costs can be overwhelming—that’s why we’ve created this “Get Informed” section.

Here, you’ll find helpful resources to guide you through topics like prior authorizations, Medicare coverage, what’s included in your well-woman visit, understanding your deductible, and our general price guide. Our goal is to provide clear, accessible information so you can feel confident and prepared for your care.

Our Price Guide

A comprehensive price guide with estimates for common appointment types is available by contacting our Billing Team. For estimates related to problem visits or consultations, please call our office to speak with a team member for a more personalized breakdown.

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What to Know About Prior Authorizations

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Your Medicare Coverage: What to Expect

Medicare may not cover all services during your annual visit. If coverage is uncertain, you’ll receive an Advanced Beneficiary Notification (ABN) form explaining your options and potential out-of-pocket costs.

Medicare covers a pelvic and breast exam and a screening pap smear every 24 months, or every 12 months if you meet high-risk criteria. Medicare Part B covers a yearly “wellness” visit, but this is distinct from a traditional physical exam. It focuses on developing a personalized prevention plan, not a physical exam. If a physical exam is performed during the visit, you may be responsible for cost-sharing.

At your annual visit, you may be offered:

Women’s Wellness Visit – A review of your health history (not covered by Medicare; $60.00).
Pelvic & Breast Exam – A physical exam without the health review.
Screening Pap Smear – Based on your age, history, and current guidelines.

Problem-based visits are fully covered by Medicare at any time, but must be scheduled as such.

Medicare Part B covers a yearly “wellness” visit, but this is distinct from a traditional physical exam. It focuses on developing a personalized prevention plan, not a physical exam. If a physical exam is performed during the visit, you may be responsible for cost-sharing.

For more details, visit www.medicare.gov or contact our Billing Team at 207-885-8400 (option 5).

Well-Woman Visits: What’s Covered and What’s Not

Under the Affordable Care Act (ACA), most private insurance plans must cover certain preventive services—including your annual well-woman exam, also referred to as a yearly or an annual exam—at no cost to you. This means no copay, deductible, or coinsurance when services are performed by an in-network provider.

Common Covered Services:
- Routine Measurements: Height, weight, blood pressure, and pulse
- Physical Exam: General assessment, including optional breast and pelvic exams
- Screenings:
- Cervical cancer: Pap test (Routine screening ages 21–30, every 3, ages 30-65 every 5 years)
- Breast cancer: Clinical breast exams; mammograms (ages 40+, every 1–2 years)
- STIs: Chlamydia, gonorrhea, HIV, and more for those at risk
- Chronic conditions: Blood pressure, cholesterol, and diabetes
- Mental health: Depression and domestic violence screening
- Vaccinations: Age- and health-appropriate immunizations
- Counseling: Topics like nutrition, weight, smoking, alcohol use, and birth control
Important Notes:
- Use In-Network Providers: Preventive services are fully covered only when received in-network.
- Additional Concerns: If new health issues are addressed during your visit (e.g., chronic condition, illness), those portions may be billed separately and could result in out-of-pocket costs.
- For the most accurate coverage details, check with your insurance provider before your visit.