How Much Does Primary Care Cost Without Insurance in 2021?
The cost of a primary care visit without insurance generally ranges from $150-$300 for a basic visit and averages $171 across major cities in the United States. For any additional services such as childhood and adult immunizations, lab testing, or prescriptions, there will be additional charges. Finding a primary care physician to monitor your health status during annual check-ups is a great way to reduce the costs of your healthcare later.
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The Cost of Primary Care
We called primary care facilities in various cities throughout the United States to get an estimate on the cost for a primary care visit without insurance. The cost of a basic wellness exam ranged from $75 to over $300. Below is the average cost of a basic primary care visit without any additional lab testing, immunizations, or other services.
Cost of Primary Care Visit By City
|Services||Cost without insurance|
|New York, NY||$149|
|Los Angeles, CA||$190|
Data was collected through outreach to multiple primary care facilities across major cities in the United States by the Mira research team.
Additional Costs of Primary Care Visits
The costs are shown in the table above just indicate the base rate for an office visit without any additional services such as immunizations, lab testing for physical exams, PAP smears, and other routine testing. Consider the following costs of additional primary care services when anticipating the costs for primary care out-of-pocket.
Cost of Additional Services at a Primary Care Visit
|Procedure Type||Average Cost of Service|
|STI Screening and Treatment||$300|
Flu test data was collected through outreach to multiple healthcare facilities across major cities in the United States by the Mira research team.
Factors That Affect the Cost of Primary Care
Many factors can affect the cost of your primary care visit. Whether you are there just for a consultation and the severity of your illness can determine the cost. Additionally, your location, access to free health clinics, and duration of your appointment can greatly influence the cost of your visit as well.
As shown in the tables above, your location can determine the cost of your primary care visit. There is also a lot of variation in cost within the same geographic region. In the same city, some primary care consultations can cost as little as $40, while others may cost upwards of $200. Therefore, it is important to call multiple facilities in your area to find the primary care provider who offers an affordable price.
New York provides free health clinics to those that cannot afford to pay out of pocket. Community health clinics are also available in select areas across the United States to reduce the cost of care.
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Duration of Appointment
The cost of your primary care visit can range depending on how long the healthcare provider spends with you. The longer the appointment and the more services requested, the more costly the appointment. Before seeing a primary care provider, you can ask the receptionist if you will be charged based on the duration of your appointment and if they have pricing information.
If you have insurance, most preventative care at in-network providers is covered even before meeting your deductible. You may be required to pay a copay for your primary care visit, which usually ranges between $15 to $25 depending on the type of health plan you have. Make sure that you visit an in-network provider or check to see if your primary care provider accepts your health insurance to save money on your visit.
If you do not have insurance, you will be required to pay for the flat rate of the office visit, plus the additional cost of services conducted. If you need to see a primary care provider but do not have insurance, Mira may be a great fit for you. Mira offers access to affordable lab testing, prescriptions, doctor’s visits, and more for only $45 per month.
Type of Services Needed
As shown in the table above, the cost of your care can depend largely on the type of services you need during your primary care visit. A full physical examination with lab work can start at just $199. However, a visit that entails a physical examination, immunizations, or any additional tests, can cost upwards of $600 at some locations if paying without insurance.
Primary Care Frequently Asked Questions (FAQs)
Below we have answered some frequently asked questions when it comes to understanding and financing primary healthcare services.
What is primary care?
Primary care focuses on preventative care to ensure you stay healthy with regular doctor’s visits, lab tests, and immunizations. Primary care physicians also help diagnose and treat occasional acute illnesses or manage chronic conditions. Primary care doctors can help treat any age group and are particularly helpful when treating an entire family to help families to stay well together or monitor genetically linked illnesses.
What are the benefits of having a primary care physician?
You can go to your primary care physician if you are feeling sick and may need to be tested for common illnesses and for regular checkups as well. Not every age group is required to get an annual checkup, but consider your current health status and how they fit into the following benefits of regular checkups:
- Identifying potentially life-threatening issues before they cause worse issues
- Early treatment of health conditions to increase the odds of a good outcome
- Routine monitoring of existing health conditions
- Staying current on vaccinations and age-appropriate screenings
- Reducing the cost of medical care associated with complications or conditions that are not caught early
Below are some of the common services provided at a primary care office:
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How often should I go to a primary care physician?
To maintain your health, it is recommended that if you are under the age of 50 and have no other pre-existing health conditions, you should visit your PCP once every one to three years. Once you turn 50, you should consider visiting a primary care doctor at least every year for a checkup, as PCPs can check for conditions such as depression, high blood pressure, cholesterol and vitamin and mineral deficiencies, and other key health indicators.
Routine checkups allow your PCP to assess any potential risks since your last exam. By having a doctor that continually evaluates your health, they will be able to better identify abnormalities to your normal health status.
How can I save money on primary care visits?
If you do not have insurance, a private primary care physician can be costly, but foregoing preventative and ongoing care altogether can accumulate your health costs later for undiagnosed medical conditions. There are some primary and preventative care services offered at local urgent care centers such as family care, flu, strep, and urine testing, even X-rays. A care membership plan such as Mira offers affordable access to Virtual Primary Care and urgent care visits for just $45 per month.
Additionally, community health centers provide primary care to help reduce the burden of the cost associated with healthcare for those without insurance. These centers are also called Federally Qualified Health Centers (FQHCs). To find a community health clinic in your area, visit this database. If you live in the New York metro area, there are also free health clinics for those that cannot afford to pay out-of-pocket.
When should I go to urgent care vs. primary care doctor?
When deciding whether your health condition can be treated at an urgent care or primary care doctor, it is important to understand that both treat similar health conditions. If you are managing a chronic condition and want ongoing care, having a primary care physician can help monitor long-term health conditions. If you need care after hours, on the weekends, or cannot get an appointment with a doctor, you can seek care at urgent care facilities as well. The cost of an urgent care visit can often be more affordable than primary care; however, building a relationship with a PCP also has clear benefits, and not every urgent care facility performs wellness exams.
Is primary care covered by health insurance?
Many services conducted at a primary care visit are often covered by health insurance even if you have not met your deductible because they are often geared toward prevention. Under the Affordable Care Act, many preventative care services are covered by your health insurance provider without copay or coinsurance or if you have not met your deductible. Covered services and screenings differ for adults and children, but typically include:
- STI Screening
- Depression Screening
- Height, weight, and body mass index
- Blood pressure screening
- Cholesterol screening
- Tuberculosis screening
- Tobacco and alcohol screening and counseling
The cost of a primary care visit when paying out of pocket averages $171, but can range between $75 to nearly $300 for a basic exam without insurance. The cost of primary care can be upwards of $600 depending on the lab tests and immunizations being done at the time of care. Engaging in primary care is a great way to prevent chronic illness later and reduce healthcare spending in the long term.
Mira offers an affordable health coverage option for primary, preventative, behavioral, and urgent care services so you can stay up to date and in control of your health needs. For just $45 per month, you also get access to up to 80 percent discounted rates on prescriptions and lab testing. You can sign up your whole family and get care the same day!
Ashley Brooks works in Healthcare Consulting and graduates with her MPH in September of 2022 from George Washington University, but graduated with her B.S. in Health Science from James Madison University in 2019. Ashley has been with Mira since June of 2021 and shares the passion for creating affordable healthcare coverage for all!