Members can schedule annual physical each calendar year

We’re frequently asked how often members are permitted to have a physical examination.

Under the terms of the Affordable Care Act, Blue Cross Blue Shield of Michigan and Blue Care Network commercial members typically qualify for an annual physical.

Health care providers scheduling annual physical appointments should remember that our plans allow an annual physical exam every calendar year. That means most members don’t need to wait 366 days for their next physical appointment. As long as the member’s plan is ACA-compliant, you can generally schedule a physical within the calendar year time frame.

Because of variations in coverage, it’s always best to check benefits and eligibility for your patients on our provider portal, Availity Essentials™.**

Here are some other guidelines to keep in mind:

• Some members may qualify for more than one physical each year, depending on their age, sex and the type of plan they have.
• Government guidelines for commercial coverage don’t apply to members who are part of the Blue Cross and Blue Shield Federal Employee Program^®, Michigan Public School Employees’ Retirement System, UAW Retiree Medical Benefits Trust or other retiree or self-funded groups that don’t follow government rules.
• Members with one of our Medicare Advantage plans (Medicare Plus Blue℠ or BCN Advantage℠) qualify for annual wellness visits. Those who are new to Medicare can receive a “Welcome to Medicare” preventive visit.
• BCN has no frequency restrictions for how often a commercial HMO member can receive a physical exam. BCN members can schedule their routine screenings at any time during the year regardless of when they had screenings in the previous year. This also applies to preventive screenings that members schedule annually, such as mammograms.

Medicare Advantage

Medicare Plus Blue℠ and BCN Advantage℠ follow guidelines set by the Centers for Medicare & Medicaid Services. More information on the frequency of Medicare screenings is available at cms.gov.**  

**Blue Cross Blue Shield of Michigan and Blue Care Network don’t own or control this website.

Availity^® is an independent company that contracts with Blue Cross Blue Shield of Michigan and Blue Care Network to offer provider portal and electronic data interchange services.