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Out-of-pocket costs included costs associated with procedures (eg, laboratory tests, immunizations) that occurred on the same day as the wellness visit in addition to any charges for the visit itself. ACA indicates Affordable Care Act; ICD-10-CM , International Statistical Classification of Diseases, Tenth Revision, Clinical Modification .

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Shafer PR , Hoagland A , Hsu HE. Trends in Well-Child Visits With Out-of-Pocket Costs in the US Before and After the Affordable Care Act. JAMA Netw Open. 2021;4(3):e211248. doi:10.1001/jamanetworkopen.2021.1248

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Trends in Well-Child Visits With Out-of-Pocket Costs in the US Before and After the Affordable Care Act

  • 1 Department of Health Law, Policy, and Management, School of Public Health, Boston University, Boston, Massachusetts
  • 2 Department of Economics, College of Arts and Sciences, Boston University, Boston, Massachusetts
  • 3 Department of Pediatrics, School of Medicine, Boston University, Boston, Massachusetts

In the US, both Medicaid and the Children’s Health Insurance Program exclude well-child care from cost sharing, but out-of-pocket costs present a barrier to accessing preventive services for privately insured children. 1 The promised elimination of these costs is a popular provision of the Affordable Care Act (ACA). Although the proportion of well-child visits with out-of-pocket costs declined from 73% before passage of the ACA to 49% in 2011 and 2012, 2 the evolution of trends in out-of-pocket costs is unknown. We used national claims data to describe cross-sectional trends in well-child visits with out-of-pocket costs from 2006 through 2018.

This cross-sectional study was deemed exempt from review, and the requirement for patient written informed consent was waived by the Boston University Institutional Review Board because deidentified data were used. We followed the Strengthening the Reporting of Observational Studies in Epidemiology ( STROBE ) reporting guideline. We used health insurance claims from 2006 through 2018 from children aged 0 to 17 years with full-year coverage each year; claims were obtained from the IBM MarketScan Commercial Claims and Encounters Database. 3

We focused on 2 outcomes: the proportion of children who had an office or outpatient visit without a wellness visit and the proportion of wellness visits resulting in an out-of-pocket cost, which were calculated annually during the study period. We stratified the sample by 2 age groups (0 to 5 years and 6 to 17 years) because these groups have a different recommended frequency of visits for wellness and other preventive services. 4 Diagnosis codes from the International Classification of Diseases, Ninth Revision (visits before October 2015) and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (visits in October 2015 and after) and Current Procedural Terminology and Healthcare Common Procedure Coding System codes used to identify preventive services were obtained from the Centers for Disease Control and Prevention and were supplemented with coding guidelines from major insurers. 5

We examined trends in visit volumes to ensure that compositional changes did not explain the findings and assessed the delivery of preventive services during non-wellness visits. We plotted the trends over time and tested for significance using linear regression. P  < .05 was considered to be statistically significant, all P values were 2-sided. Data were analyzed from June 10, 2020, to January 15, 2021, using SAS, version 9.4 (SAS Institute, Inc) and Stata, version 16 (StataCorp).

The sample consists of 88 863 727 person-years from privately insured children in 48 states, with a total of 371 573 184 visits across the study period from 2006 through 2018 ( Table ). The mean (SD) age of participants was 9.19 (5.09) years, and 15 945 616 of 31 247 534 participants were male (51.03%). The proportion of children with at least 1 office or outpatient visit and without a wellness visit declined from 39.3% in 2006 to 29.0% by 2018 (coefficient on linear time trend: −0.79 percentage points; 95% CI, −1.11 to −0.47; P  < .001) ( Figure , A). The volume and relative share of total visits per child (coefficient on linear time trend: 0.01 visits; 95% CI, 0.01-0.02; P  = .03) and wellness visits per child (coefficient on linear time trend: 0.02 visits; 95% CI, 0.01-0.02; P  < .001) remained stable over time ( Figure , B). Older children had office visits or outpatient care without a wellness visit at higher rates than younger children during the study period ( Figure , A). The percentage of wellness visits with an associated out-of-pocket cost declined from 54.2% in 2010 (the year that the ACA was passed) to 14.5% in 2018 (coefficient on linear time trend: −5.63 percentage points; 95% CI −6.96 to −4.31; P  < .001) ( Figure , C). In addition, the percentage of non-wellness visits with associated preventive services increased approximately 60%, from 1.8% in 2006 to 3.7% in 2018 (coefficient on linear time trend: 0.09 percentage points; 95% CI, 0.03-0.15; P  = .005).

Following passage of the ACA, engagement of privately insured children in well-child care increased and the proportion of families incurring out-of-pocket costs for this care declined. However, approximately 1 of 7 wellness visits still results in out-of-pocket costs. Delivery of preventive services is increasing during non-wellness visits, indicating that providers may be encouraging prevention at any opportunity. This study is limited because specific insurers were not analyzed; however, there is considerable overlap in preventive coding guidelines, and we believe that our coding scheme is inclusive of federal guidance and several major insurers. There are several reasons why parents still receive unexpected bills for well-child care but the continued decline in costs as a barrier is encouraging. 6

Accepted for Publication: January 20, 2021.

Published: March 12, 2021. doi:10.1001/jamanetworkopen.2021.1248

Open Access: This is an open access article distributed under the terms of the CC-BY License . © 2021 Shafer PR et al. JAMA Network Open .

Corresponding Author: Paul R. Shafer, PhD, Department of Health Law, Policy, and Management, School of Public Health, Boston University, 715 Albany St, Talbot 340 West, Boston, MA 02118 ( [email protected] ).

Author Contributions : Dr Shafer and Mr Hoagland had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Shafer.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Shafer, Hoagland.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Shafer, Hoagland.

Administrative, technical, or material support: Hoagland.

Supervision: Shafer.

Conflict of Interest Disclosures: Mr Hoagland reported receiving a Student Summer Research Award from the Boston University Institute for Health System Innovation and Policy. No other disclosures were reported.

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A Comprehensive Guide to Well-child Visits

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The Importance of Well-child Visits at Every Age

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Keep on top of your child’s health by scheduling a well-child visit today. Our pediatrician offices are conveniently located across Kentucky and Southern Indiana.

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Every parent wants to know that their child is growing and healthy. A well-child visit is a crucial part of every child’s health care journey, from the time they are born until they reach adulthood.

A well-child visit is a regularly scheduled health check up with your child’s pediatrician . These appointments serve many important purposes. They focus on your child’s overall health, preventive care, growth and developmental milestones, immunizations, plus serve as a time for parents to discuss any questions or concerns they may have about their child’s health or parenting. These visits also can help catch any potential health issues early and connect your child with additional support if needed for specific physical or mental health concerns. Building a strong relationship with a pediatrician is an important part of your child’s health care journey. Pediatricians are specially trained to focus on children’s health. They will conduct physical and mental health screenings, along with a full physical health assessment, and offer medical guidance to your child and family. The benefit of your child seeing a pediatrician is the continuity it provides of your child seeing the same doctor(s) as they grow up.

Well-child visits may seem like a routine part of your child’s growth, but they play an important role in their overall health care, including their physical, mental, social and emotional well-being. How often you need to schedule your child’s well-child visits will vary based on their age and developmental needs.

During a baby’s first year, they grow rapidly and will require more frequent visits with the pediatrician to ensure they are reaching their developmental milestones on time. Toddlers will continue to see their pediatrician at regular intervals throughout the year, and young children will need to check in with their pediatrician at least once a year. The full well-child visit schedule recommended by the American Academy of Pediatrics, is listed below:

By becoming a part of your family’s medical home, the pediatricians with Norton Children’s Medical Group , can get to know your family on an individual basis, become familiar with your child’s health care needs and unique personality, plus offer the best tools, information and guidance to empower every child and parent to live a healthy lifestyle.

Although well-child visits, on their own, are not legally mandated, health physicals often are required for entry into school or day care and for participation in sports. Many state laws require these types of health check ups and immunizations for school children, and the well-child visit can serve as a great time to complete these requirements with a health care professional. Regularly scheduled check ups with your child’s pediatrician are strongly recommended by medical professionals to make sure your child receives the proper care at every stage of their growth.

During your child’s visit, you can expect your pediatrician to do the following:

  • The pediatrician will perform a thorough physical exam to assess your child’s general health, growth and any potential physical concerns. This includes regular screenings for physical and mental health issues.
  • Observing your child’s developmental progress and behavior helps identify any developmental delays or behavioral issues.
  • The pediatrician provides guidance on proper nutrition and feeding practices tailored to your child’s age and needs.
  • Updating your child’s medical history and sharing any family health history helps the pediatrician make informed decisions about your child’s care.
  • Well-child visits include getting recommended vaccinations to protect your child from various diseases. Keeping vaccinations up to date is crucial for their health and safety.
  • Well-child visits provide a place for you to ask questions, share concerns and seek guidance on parenting, health and development.
  • Having a record of your child’s medical history and vaccinations helps ensure accurate and effective care.
  • If your child is a patient at one of our pediatrician offices, parents or guardians have proxy access to the child’s Norton MyChart account to review medical history and immunization records.
  • Inform the pediatrician about any medications your child takes. It helps to bring the specific prescription bottles to confirm the name and dosage of the medications.
  • Sharing recent health changes or concerns (both physical and mental) ensures that the pediatrician has the most up-to-date information to provide appropriate care.
  • Mention any developmental milestones your child has reached since the last visit or if they have experienced any backslides.
  • Bringing a notebook and pen or device (such as the Notes app or voice recorder on your phone) to take notes on the pediatrician’s recommendations and advice helps you remember and put their guidance into practice.
  • Many insurance plans cover well-child visits as preventive care. At Norton Children’s Medical Group, we accept Medicaid and most commercial insurance plans.
  • Understanding your coverage helps you plan financially. Confirming your insurance coverage before the visit helps you avoid unexpected expenses. Staying within your insurance network can help minimize out-of-pocket costs for well-child visits.

Well-child check ups are more than just routine appointments. They are a cornerstone for monitoring and supporting your child’s overall health and development. It is important to follow the recommended well-child visit schedule to ensure your child’s pediatrician can screen them for any health issues, provide necessary preventive care and immunizations, and give them the physical and mental support they need to achieve optimal health. It’s also a time for parents to receive support and helpful information from the pediatrician. Prioritizing your child’s health can help set them up for a brighter, healthier and happier future. Building a strong relationship with a pediatrician can help encourage more positive health care experiences and better long-term health later in life.

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  • Medicaid and most major commercial insurance plans accepted

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How Much Does a Well Baby Doctor Visit Cost?

Certified CFA

Welcoming a new baby is an exciting, rewarding experience. As a parent, you want to do everything possible to safeguard your child’s health and well-being in their critical early years.

Well-baby visits with a pediatrician play an integral role in monitoring your baby’s development, catching potential issues early, and providing needed immunizations. However, these services come at a cost that must be planned for.

With some diligence and planning ahead, you can secure quality affordable medical care for your baby’s first year and beyond. Monitoring your child’s health is a top priority, but finding cost-effective solutions provides peace of mind. Let’s take a deeper look at how to make well-baby visits work within your family’s financial means.

Unlike a standard co-pay, fees for well-baby exams can vary significantly based on your specific circumstances. Gaining clarity on cost drivers allows more accurate budgeting.

According to the Kaiser Family Foundation 2022 survey, routine well-child visits cost between $20 and $600 per exam . Here’s what to expect:

  • Uninsured –  $300 to $600 per exam  on average
  • Insured, without meeting deductible –  $100 to $300 per visit
  • Insured, after meeting deductible –  $20 to $50 copay per visit

Your total first year well exam expenses could range anywhere from $700 to $3,000+ . Geography, your insurer, and specific pediatric office fees will determine your actual rates.

According to Care Better, the average cost of a pediatrician visit for uninsured patients ranges from $100 to $250 for new patient visits, with recurring visits possibly slightly lower. Well-baby visits typically cost between $100 to $150 , varying by state.

Be aware that additional costs beyond the exam itself may apply, including fees for screenings, lab work, specialist referrals or consultations, out-of-network charges, prescription medications, medical equipment, and more during visits. Immunization costs must also be accounted for separately.

The Many Factors Impacting the Price of Well-Baby Visits

The exact cost per visit depends on several key factors:

  • Insurance  – Copays, deductibles, coinsurance percentages, in-network discounts, and covered services all affect out-of-pocket fees.
  • Pediatrician or clinic  – Providers determine their own charges for exams and services based on overhead, administrative costs, and other business factors.
  • Geographic location  – Healthcare costs vary greatly by region, state, and even within the same city.
  • Services rendered – The number and types of screenings, tests, injections, lab work, and specialized assessments conducted during the visit impact costs.
  • Visit frequency  – More wellness exams mean higher overall annual prices for care.
  • Incidentals  – Other one-off charges for medical forms, prescription medications, equipment rentals, etc may arise.

Why the Range in Prices is so Extreme

There are clear reasons why average well-baby checkup costs have such an incredibly wide range nationally.

At the lower end are insured families with excellent in-network coverage who’ve met their deductible for the year. Their out-of-pocket cost per visit may simply be a minimal copay of $20-50 . Total first-year expenses could be as little as $700 or so .

Meanwhile, uninsured families paying 100% out-of-pocket can expect to spend $300 or more per exam, even with some discounting. Their annual costs could approach $3,000+ in the baby’s first year.

Those with insurance but unmet deductibles land in the middle, potentially owing $100-$300 per visit until reaching their deductible threshold. Their yearly total would likely fall between $1,000-$2,000 .

Geography also plays a major role in cost variance. Average prices in urban areas and on the coasts tend to be higher than in rural regions and the Midwest. Competitive insurance markets and Medicaid-managed care can reduce prices in some states as well.

Out-of-Pocket Costs Can Exceed Reimbursed Rates

One surprising aspect of well-baby visit costs is that insured patients may sometimes pay more per visit out-of-pocket than the actual billed charge prior to insurance adjustments.

For example, your pediatrician may bill $150 for a routine exam, which is discounted to $125 by your insurer. But if your plan has a high unmet deductible and 30% coinsurance, you may owe the full $150 at that visit.

This occurs because insured rates account for contracted discounts which don’t apply to patient responsibility until the deductible is satisfied. Be sure to clarify out-of-pocket costs with your provider’s billing department.

Schedule of Well-Baby Visits in the First Year

To budget and plan for your baby’s routine medical care, it helps to understand the standard schedule of recommended wellness exams in the first year along with typical fees charged.

Importance of Following the Well-Baby Visit Schedule

The American Academy of Pediatrics (AAP) delineates a well-baby visit schedule based on age to ensure proper monitoring of growth milestones and administering vaccinations. Following this routine allows your pediatrician to screen hearing, vision, development, and other health factors at important times.

Catching any potential issues early through these well-checks provides the opportunity for early intervention, treatment, and parent education for the best outcomes. Don’t skip recommended visits due to cost concerns without discussing other options with your provider first.

The Standard Well-Baby Check-Up Schedule

  • Newborn: Initial hospital visit or within 3-5 days after discharge
  • 12 months – Includes first-year vaccinations & developmental screening
  • 24 months – Includes age 2 vaccinations & autism screening

Annual visits continue ages 3-6. Additional sick visits occur as needed.

Estimating the Costs Associated with Routine Well-Baby Visits

Using the average cost ranges discussed earlier, we can estimate typical fees associated with each recommended well visit:

  • The exam portion will likely cost  $100 – $300 per visit  based on insurance
  • Required vaccinations may add $100 – $350 per visit
  • Additional screening tests  like lab work, hearing tests, etc may each cost  $50 – $200

Conservatively, you’ll spend around $1,500 – $2,500 in the first year for well-baby exams and immunizations. Be prepared for higher costs if you have testing, see specialists, need prescriptions, or lack insurance.

Understanding these expected expenses allows you to budget and financially prepare for this essential care.

Insurance Coverage Can Vary Widely

Navigating health insurance for your newborn is crucial yet confusing. Plan specifics dramatically impact your out-of-pocket costs. Let’s demystify this process.

Securing Coverage for Your Baby

If your baby won’t be covered under your existing plan, purchase a marketplace policy or employer-based coverage by their birth to avoid gaps. Shop insurers and policies carefully, assessing premiums, provider networks, deductibles, copays, coinsurance, out-of-pocket maximums, and covered services.

You can also read our articles about the cost of baby formula , daycare , and the cost of having a baby .

Having no lapse in coverage protects your child and reduces newborn care costs. Read your insurance materials thoroughly or call member services with questions.

The Ins and Outs of Health Insurance Terminology

Here are some health insurance terms and how they relate to your costs:

  • Premium – The upfront monthly or yearly amount you pay for coverage.
  • Deductible – The amount owed for care before insurance coverage kicks in, often $1000-$5000. You pay 100% until met.
  • Copay – A fixed dollar amount per visit after deductible, typically $20-$50 for primary care.
  • Coinsurance – The percentage you pay after deductible, such as 20%.
  • Out-of-pocket max – The most you’ll spend for essential covered care annually, generally $3000-$6000.
  • Allowed amount – The fee agreed upon by your insurer and provider for a service. This is the basis for determining your responsibility.
  • In-network providers – Doctors within your plan’s network who offer better rates. Go in-network when possible.
  • Preauthorization -approval required by your insurer before certain services. Check to avoid surprise bills.
  • Covered services – Specific well-baby visit elements, tests, specialists, etc included in your policy. Review closely.

Questions to Ask About Your Health Insurance Coverage

Well-Baby Doctor Visit

  • Is my pediatrician/clinic in-network? Are labs and specialists they use in-network?
  • What is my deductible and has it been met yet?
  • What are my copays for sick visits vs. well visits?
  • What coinsurance percentage applies?
  • What’s my out-of-pocket maximum?
  • Does my policy cover well-baby check-ups and which specific services?
  • Are there service limits? Preauthorization requirements?
  • Can I be charged for fees outside the allowed amount?
  • What vaccinations are covered? What do they cost?

Once armed with this information, you can accurately estimate your potential out-of-pocket responsibility.

Budgeting Strategies

With copays, coinsurance, unexpected medical fees, and other new baby expenses, healthcare costs can quickly strain the family budget. Proactively planning ahead is key to weathering this financial challenge.

Look Beyond Just the Cost Per Visit

The fees for well-baby appointments are just one portion of your child’s overall medical expenses that first year. You’ll also need to budget for:

  • Health insurance premiums
  • Hospital bills for delivery and newborn care
  • Prescriptions, medical equipment/supplies, and over-the-counter medicines
  • Urgent care or ER visits for illnesses
  • Dental and eye care
  • Travel costs related to care

Don’t overlook these additional items when doing your healthcare budget. Their unexpected timing can also wreak havoc on finances if unprepared.

Tips to Financially Prepare

With smart planning, you can limit stress when those pediatric bills start rolling in:

  • Call your insurer and doctor to learn prices and your responsibility
  • Ask about bundled pricing or package deals for bundled well visits upfront
  • Calculate your deductible and plan to meet it
  • Establish an emergency fund for medical surprises
  • Open a flexible spending account to pay bills tax-free

Check if you qualify for WIC, Medicaid, or other assistance programs if uninsured. Understanding costs allows you to be proactive and stay in control.

When Budgeting, Plan for More Visits

While only 6-8 well-baby visits are guideline-recommended the first year, budgeting for additional sick visits just in case is wise. Babies commonly have:

  • 8-10 colds annually
  • 6-8 ear infections before age 1
  • 3-9 bouts of diarrhea per year
  • Viruses causing fevers

Your budget should account for at least 2-4 extra unplanned pediatric appointments to treat routine illnesses in year one. Check with your insurer about your urgent care vs ER visit costs too. Staying financially prepared provides peace of mind if your baby does get sick.

Seeking Out Affordable Well-Baby Care

Despite diligent planning, some families still struggle to manage healthcare costs amidst limited incomes and other financial challenges. Many public and private resources exist to provide pediatric care assistance in these situations.

Government-Sponsored Healthcare for Children

Medicaid, SCHIP, and Tricare are government-sponsored health programs providing free or subsidized medical care for children in households under certain income limits. Coverage includes well-child visits along with hospitalizations, prescriptions, hearing and vision services, dental care, medical equipment and more at little to no cost based on state eligibility rules. These programs are invaluable for lower-income families.

Non-Profits and Community Health Centers

Various organizations assist families struggling to afford pediatric expenses. Charities like Ronald McDonald house provide housing when kids need extended hospital care. Local non-profits and community health centers may supply vouchers or grants to cover well-baby visits for uninsured or underinsured households.

Do research to identify groups offering pediatric health assistance in your region. Your OB, hospital social worker or health department can also refer possible resources. Don’t be afraid to ask for help – your baby’s health comes first.

How Hospital Charity Care Helps

Most hospitals provide charity care – free or discounted services – for uninsured and underinsured patients, including families with newborns.

If household income falls below 200-400% of the Federal Poverty Level, you may qualify for partially or fully reduced pediatric healthcare fees, including well-baby visits.

Check with hospital billing departments for information on potential savings through charity care programs. But apply promptly before outstanding balances go to collections, negatively impacting your eligibility.

Partnering with Your Pediatrician

Don’t be afraid to have an open conversation with your children’s doctor about cost concerns and payment options. Most pediatricians aim to ensure all patients receive needed care regardless of financial challenges.

Many allow establishing installment payment plans for families, waive or discount visit fees, connect patients with community resources, identify affordable prescription options, and go above and beyond to help during difficult times.

Communicating about monetary challenges allows your pediatrician to assist as an advocate. Medical providers want to see kids thrive.

Next Steps to Affordable Well-Baby Care

Providing your new baby with the best possible medical care during the vital first year of rapid growth and development is any parent’s top priority. But the costs associated with well-visits, screenings, vaccinations, and more can certainly be daunting. Hopefully, this guide has shed light on smarter budgeting for this essential pediatric care through:

  • Learning the average costs and cost drivers for well-baby visits
  • Understanding your health insurance and out-of-pocket responsibility
  • Budgeting for deductibles, copays, coinsurance, unplanned visits and expenses
  • Following the recommended visit schedule for your child
  • Identifying ways to save on costs proactively
  • Researching financial assistance resources for affordable care options

As you embark on this exciting parenting journey, stay savvy about your healthcare plan specifics, talk costs with your providers upfront, plan for extra budget cushion, and don’t hesitate to consult financial counselors to protect both your baby’s health and your family’s finances. Planning ahead is key, but assistance is out there if challenges emerge. Here’s to a healthy, happy first year!

Frequently Asked Questions

How often do babies see the doctor in the first year.

Babies typically visit the doctor 8-10 times in the first year for wellness check-ups and vaccinations. The first visit is 3-5 days after hospital discharge, followed by exams at 1, 2, 4, 6, 9, and 12 months old. 1-2 additional sick visits for common illnesses are also common.

When should I schedule my baby’s first pediatrician appointment?

Schedule your baby’s first well visit within 3-5 days of hospital discharge . This critical newborn check ensures feeding, weight gain, and jaundice are on track. Routine well-baby visits continue monthly for the first 6 months, then every 3 months after. Seek immediate care if the baby seems ill.

Can I skip my baby’s well visits if I’m worried about costs?

No, well-baby visits are highly recommended and provide vital preventive care. Check-ups assess growth, administer vaccines, and screen development at key milestones. Speak with your pediatrician about costs if needed – they aim to ensure care is received. Never skip visits, but seek financial assistance programs if cost prohibitive.

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I would really love to get ahold of the actual data used to come up with these numbers? Sources if you will. It would be helpful for sure

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We will email you our full research.

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KATHERINE TURNER, MD

Am Fam Physician. 2018;98(6):347-353

Related letter: Well-Child Visits Provide Physicians Opportunity to Deliver Interconception Care to Mothers

Author disclosure: No relevant financial affiliations.

The well-child visit allows for comprehensive assessment of a child and the opportunity for further evaluation if abnormalities are detected. A complete history during the well-child visit includes information about birth history; prior screenings; diet; sleep; dental care; and medical, surgical, family, and social histories. A head-to-toe examination should be performed, including a review of growth. Immunizations should be reviewed and updated as appropriate. Screening for postpartum depression in mothers of infants up to six months of age is recommended. Based on expert opinion, the American Academy of Pediatrics recommends developmental surveillance at each visit, with formal developmental screening at nine, 18, and 30 months and autism-specific screening at 18 and 24 months; the U.S. Preventive Services Task Force found insufficient evidence to make a recommendation. Well-child visits provide the opportunity to answer parents' or caregivers' questions and to provide age-appropriate guidance. Car seats should remain rear facing until two years of age or until the height or weight limit for the seat is reached. Fluoride use, limiting or avoiding juice, and weaning to a cup by 12 months of age may improve dental health. A one-time vision screening between three and five years of age is recommended by the U.S. Preventive Services Task Force to detect amblyopia. The American Academy of Pediatrics guideline based on expert opinion recommends that screen time be avoided, with the exception of video chatting, in children younger than 18 months and limited to one hour per day for children two to five years of age. Cessation of breastfeeding before six months and transition to solid foods before six months are associated with childhood obesity. Juice and sugar-sweetened beverages should be avoided before one year of age and provided only in limited quantities for children older than one year.

Well-child visits for infants and young children (up to five years) provide opportunities for physicians to screen for medical problems (including psychosocial concerns), to provide anticipatory guidance, and to promote good health. The visits also allow the family physician to establish a relationship with the parents or caregivers. This article reviews the U.S. Preventive Services Task Force (USPSTF) and the American Academy of Pediatrics (AAP) guidelines for screenings and recommendations for infants and young children. Family physicians should prioritize interventions with the strongest evidence for patient-oriented outcomes, such as immunizations, postpartum depression screening, and vision screening.

Clinical Examination

The history should include a brief review of birth history; prematurity can be associated with complex medical conditions. 1 Evaluate breastfed infants for any feeding problems, 2 and assess formula-fed infants for type and quantity of iron-fortified formula being given. 3 For children eating solid foods, feeding history should include everything the child eats and drinks. Sleep, urination, defecation, nutrition, dental care, and child safety should be reviewed. Medical, surgical, family, and social histories should be reviewed and updated. For newborns, review the results of all newborn screening tests ( Table 1 4 – 7 ) and schedule follow-up visits as necessary. 2

PHYSICAL EXAMINATION

A comprehensive head-to-toe examination should be completed at each well-child visit. Interval growth should be reviewed by using appropriate age, sex, and gestational age growth charts for height, weight, head circumference, and body mass index if 24 months or older. The Centers for Disease Control and Prevention (CDC)-recommended growth charts can be found at https://www.cdc.gov/growthcharts/who_charts.htm#The%20WHO%20Growth%20Charts . Percentiles and observations of changes along the chart's curve should be assessed at every visit. Include assessment of parent/caregiver-child interactions and potential signs of abuse such as bruises on uncommonly injured areas, burns, human bite marks, bruises on nonmobile infants, or multiple injuries at different healing stages. 8

The USPSTF and AAP screening recommendations are outlined in Table 2 . 3 , 9 – 27 A summary of AAP recommendations can be found at https://www.aap.org/en-us/Documents/periodicity_schedule.pdf . The American Academy of Family Physicians (AAFP) generally adheres to USPSTF recommendations. 28

MATERNAL DEPRESSION

Prevalence of postpartum depression is around 12%, 22 and its presence can impair infant development. The USPSTF and AAP recommend using the Edinburgh Postnatal Depression Scale (available at https://www.aafp.org/afp/2010/1015/p926.html#afp20101015p926-f1 ) or the Patient Health Questionnaire-2 (available at https://www.aafp.org/afp/2012/0115/p139.html#afp20120115p139-t3 ) to screen for maternal depression. The USPSTF does not specify a screening schedule; however, based on expert opinion, the AAP recommends screening mothers at the one-, two-, four-, and six-month well-child visits, with further evaluation for positive results. 23 There are no recommendations to screen other caregivers if the mother is not present at the well-child visit.

PSYCHOSOCIAL

With nearly one-half of children in the United States living at or near the poverty level, assessing home safety, food security, and access to safe drinking water can improve awareness of psychosocial problems, with referrals to appropriate agencies for those with positive results. 29 The prevalence of mental health disorders (i.e., primarily anxiety, depression, behavioral disorders, attention-deficit/hyperactivity disorder) in preschool-aged children is around 6%. 30 Risk factors for these disorders include having a lower socioeconomic status, being a member of an ethnic minority, and having a non–English-speaking parent or primary caregiver. 25 The USPSTF found insufficient evidence regarding screening for depression in children up to 11 years of age. 24 Based on expert opinion, the AAP recommends that physicians consider screening, although screening in young children has not been validated or standardized. 25

DEVELOPMENT AND SURVEILLANCE

Based on expert opinion, the AAP recommends early identification of developmental delays 14 and autism 10 ; however, the USPSTF found insufficient evidence to recommend formal developmental screening 13 or autism-specific screening 9 if the parents/caregivers or physician have no concerns. If physicians choose to screen, developmental surveillance of language, communication, gross and fine movements, social/emotional development, and cognitive/problem-solving skills should occur at each visit by eliciting parental or caregiver concerns, obtaining interval developmental history, and observing the child. Any area of concern should be evaluated with a formal developmental screening tool, such as Ages and Stages Questionnaire, Parents' Evaluation of Developmental Status, Parents' Evaluation of Developmental Status-Developmental Milestones, or Survey of Well-Being of Young Children. These tools can be found at https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/Screening/Pages/Screening-Tools.aspx . If results are abnormal, consider intervention or referral to early intervention services. The AAP recommends completing the previously mentioned formal screening tools at nine-, 18-, and 30-month well-child visits. 14

The AAP also recommends autism-specific screening at 18 and 24 months. 10 The USPSTF recommends using the two-step Modified Checklist for Autism in Toddlers (M-CHAT) screening tool (available at https://m-chat.org/ ) if a physician chooses to screen a patient for autism. 10 The M-CHAT can be incorporated into the electronic medical record, with the possibility of the parent or caregiver completing the questionnaire through the patient portal before the office visit.

IRON DEFICIENCY

Multiple reports have associated iron deficiency with impaired neurodevelopment. Therefore, it is essential to ensure adequate iron intake. Based on expert opinion, the AAP recommends supplements for preterm infants beginning at one month of age and exclusively breastfed term infants at six months of age. 3 The USPSTF found insufficient evidence to recommend screening for iron deficiency in infants. 19 Based on expert opinion, the AAP recommends measuring a child's hemoglobin level at 12 months of age. 3

Lead poisoning and elevated lead blood levels are prevalent in young children. The AAP and CDC recommend a targeted screening approach. The AAP recommends screening for serum lead levels between six months and six years in high-risk children; high-risk children are identified by location-specific risk recommendations, enrollment in Medicaid, being foreign born, or personal screening. 21 The USPSTF does not recommend screening for lead poisoning in children at average risk who are asymptomatic. 20

The USPSTF recommends at least one vision screening to detect amblyopia between three and five years of age. Testing options include visual acuity, ocular alignment test, stereoacuity test, photoscreening, and autorefractors. The USPSTF found insufficient evidence to recommend screening before three years of age. 26 The AAP, American Academy of Ophthalmology, and the American Academy of Pediatric Ophthalmology and Strabismus recommend the use of an instrument-based screening (photoscreening or autorefractors) between 12 months and three years of age and annual visual acuity screening beginning at four years of age. 31

IMMUNIZATIONS

The AAFP recommends that all children be immunized. 32 Recommended vaccination schedules, endorsed by the AAP, the AAFP, and the Advisory Committee on Immunization Practices, are found at https://www.cdc.gov/vaccines/schedules/hcp/child-adolescent.html . Immunizations are usually administered at the two-, four-, six-, 12-, and 15- to 18-month well-child visits; the four- to six-year well-child visit; and annually during influenza season. Additional vaccinations may be necessary based on medical history. 33 Immunization history should be reviewed at each wellness visit.

Anticipatory Guidance

Injuries remain the leading cause of death among children, 34 and the AAP has made several recommendations to decrease the risk of injuries. 35 – 42 Appropriate use of child restraints minimizes morbidity and mortality associated with motor vehicle collisions. Infants need a rear-facing car safety seat until two years of age or until they reach the height or weight limit for the specific car seat. Children should then switch to a forward-facing car seat for as long as the seat allows, usually 65 to 80 lb (30 to 36 kg). 35 Children should never be unsupervised around cars, driveways, and streets. Young children should wear bicycle helmets while riding tricycles or bicycles. 37

Having functioning smoke detectors and an escape plan decreases the risk of fire- and smoke-related deaths. 36 Water heaters should be set to a maximum of 120°F (49°C) to prevent scald burns. 37 Infants and young children should be watched closely around any body of water, including water in bathtubs and toilets, to prevent drowning. Swimming pools and spas should be completely fenced with a self-closing, self-latching gate. 38

Infants should not be left alone on any high surface, and stairs should be secured by gates. 43 Infant walkers should be discouraged because they provide no benefit and they increase falls down stairs, even if stair gates are installed. 39 Window locks, screens, or limited-opening windows decrease injury and death from falling. 40 Parents or caregivers should also anchor furniture to a wall to prevent heavy pieces from toppling over. Firearms should be kept unloaded and locked. 41

Young children should be closely supervised at all times. Small objects are a choking hazard, especially for children younger than three years. Latex balloons, round objects, and food can cause life-threatening airway obstruction. 42 Long strings and cords can strangle children. 37

DENTAL CARE

Infants should never have a bottle in bed, and babies should be weaned to a cup by 12 months of age. 44 Juices should be avoided in infants younger than 12 months. 45 Fluoride use inhibits tooth demineralization and bacterial enzymes and also enhances remineralization. 11 The AAP and USPSTF recommend fluoride supplementation and the application of fluoride varnish for teeth if the water supply is insufficient. 11 , 12 Begin brushing teeth at tooth eruption with parents or caregivers supervising brushing until mastery. Children should visit a dentist regularly, and an assessment of dental health should occur at well-child visits. 44

SCREEN TIME

Hands-on exploration of their environment is essential to development in children younger than two years. Video chatting is acceptable for children younger than 18 months; otherwise digital media should be avoided. Parents and caregivers may use educational programs and applications with children 18 to 24 months of age. If screen time is used for children two to five years of age, the AAP recommends a maximum of one hour per day that occurs at least one hour before bedtime. Longer usage can cause sleep problems and increases the risk of obesity and social-emotional delays. 46

To decrease the risk of sudden infant death syndrome (SIDS), the AAP recommends that infants sleep on their backs on a firm mattress for the first year of life with no blankets or other soft objects in the crib. 45 Breastfeeding, pacifier use, and room sharing without bed sharing protect against SIDS; infant exposure to tobacco, alcohol, drugs, and sleeping in bed with parents or caregivers increases the risk of SIDS. 47

DIET AND ACTIVITY

The USPSTF, AAFP, and AAP all recommend breastfeeding until at least six months of age and ideally for the first 12 months. 48 Vitamin D 400 IU supplementation for the first year of life in exclusively breastfed infants is recommended to prevent vitamin D deficiency and rickets. 49 Based on expert opinion, the AAP recommends the introduction of certain foods at specific ages. Early transition to solid foods before six months is associated with higher consumption of fatty and sugary foods 50 and an increased risk of atopic disease. 51 Delayed transition to cow's milk until 12 months of age decreases the incidence of iron deficiency. 52 Introduction of highly allergenic foods, such as peanut-based foods and eggs, before one year decreases the likelihood that a child will develop food allergies. 53

With approximately 17% of children being obese, many strategies for obesity prevention have been proposed. 54 The USPSTF does not have a recommendation for screening or interventions to prevent obesity in children younger than six years. 54 The AAP has made several recommendations based on expert opinion to prevent obesity. Cessation of breastfeeding before six months and introduction of solid foods before six months are associated with childhood obesity and are not recommended. 55 Drinking juice should be avoided before one year of age, and, if given to older children, only 100% fruit juice should be provided in limited quantities: 4 ounces per day from one to three years of age and 4 to 6 ounces per day from four to six years of age. Intake of other sugar-sweetened beverages should be discouraged to help prevent obesity. 45 The AAFP and AAP recommend that children participate in at least 60 minutes of active free play per day. 55 , 56

Data Sources: Literature search was performed using the USPSTF published recommendations ( https://www.uspreventiveservicestaskforce.org/BrowseRec/Index/browse-recommendations ) and the AAP Periodicity table ( https://www.aap.org/en-us/Documents/periodicity_schedule.pdf ). PubMed searches were completed using the key terms pediatric, obesity prevention, and allergy prevention with search limits of infant less than 23 months or pediatric less than 18 years. The searches included systematic reviews, randomized controlled trials, clinical trials, and position statements. Essential Evidence Plus was also reviewed. Search dates: May through October 2017.

Gauer RL, Burket J, Horowitz E. Common questions about outpatient care of premature infants. Am Fam Physician. 2014;90(4):244-251.

American Academy of Pediatrics; Committee on Fetus and Newborn. Hospital stay for healthy term newborns. Pediatrics. 2010;125(2):405-409.

Baker RD, Greer FR Committee on Nutrition, American Academy of Pediatrics. Diagnosis and prevention of iron deficiency and iron-deficiency anemia in infants and young children (0–3 years of age). Pediatrics. 2010;126(5):1040-1050.

Mahle WT, Martin GR, Beekman RH, Morrow WR Section on Cardiology and Cardiac Surgery Executive Committee. Endorsement of Health and Human Services recommendation for pulse oximetry screening for critical congenital heart disease. Pediatrics. 2012;129(1):190-192.

American Academy of Pediatrics Newborn Screening Authoring Committee. Newborn screening expands: recommendations for pediatricians and medical homes—implications for the system. Pediatrics. 2008;121(1):192-217.

American Academy of Pediatrics, Joint Committee on Infant Hearing. Year 2007 position statement: principles and guidelines for early hearing detection and intervention programs. Pediatrics. 2007;120(4):898-921.

Maisels MJ, Bhutani VK, Bogen D, Newman TB, Stark AR, Watchko JF. Hyperbilirubinemia in the newborn infant > or = 35 weeks' gestation: an update with clarifications. Pediatrics. 2009;124(4):1193-1198.

Christian CW Committee on Child Abuse and Neglect, American Academy of Pediatrics. The evaluation of suspected child physical abuse [published correction appears in Pediatrics . 2015;136(3):583]. Pediatrics. 2015;135(5):e1337-e1354.

Siu AL, Bibbins-Domingo K, Grossman DC, et al. Screening for autism spectrum disorder in young children: U.S. Preventive Services Task Force recommendation statement. JAMA. 2016;315(7):691-696.

Johnson CP, Myers SM American Academy of Pediatrics Council on Children with Disabilities. Identification and evaluation of children with autism spectrum disorders. Pediatrics. 2007;120(5):1183-1215.

Moyer VA. Prevention of dental caries in children from birth through age 5 years: U.S. Preventive Services Task Force recommendation statement. Pediatrics. 2014;133(6):1102-1111.

Clark MB, Slayton RL American Academy of Pediatrics Section on Oral Health. Fluoride use in caries prevention in the primary care setting. Pediatrics. 2014;134(3):626-633.

Siu AL. Screening for speech and language delay and disorders in children aged 5 years and younger: U.S. Preventive Services Task Force recommendation statement. Pediatrics. 2015;136(2):e474-e481.

Council on Children with Disabilities, Section on Developmental Behavioral Pediatrics, Bright Futures Steering Committee, Medical Home Initiatives for Children with Special Needs Project Advisory Committee. Identifying infants and young children with developmental disorders in the medical home: an algorithm for developmental surveillance and screening [published correction appears in Pediatrics . 2006;118(4):1808–1809]. Pediatrics. 2006;118(1):405-420.

Bibbins-Domingo K, Grossman DC, Curry SJ, et al. Screening for lipid disorders in children and adolescents: U.S. Preventive Services Task Force recommendation statement. JAMA. 2016;316(6):625-633.

National Heart, Lung, and Blood Institute. Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents. October 2012. https://www.nhlbi.nih.gov/sites/default/files/media/docs/peds_guidelines_full.pdf . Accessed May 9, 2018.

Moyer VA. Screening for primary hypertension in children and adolescents: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2013;159(9):613-619.

Flynn JT, Kaelber DC, Baker-Smith CM, et al. Clinical practice guideline for screening and management of high blood pressure in children and adolescents [published correction appears in Pediatrics . 2017;140(6):e20173035]. Pediatrics. 2017;140(3):e20171904.

Siu AL. Screening for iron deficiency anemia in young children: USPSTF recommendation statement. Pediatrics. 2015;136(4):746-752.

U.S. Preventive Services Task Force. Screening for elevated blood lead levels in children and pregnant women. Pediatrics. 2006;118(6):2514-2518.

Screening Young Children for Lead Poisoning: Guidance for State and Local Public Health Officials . Atlanta, Ga.: U.S. Public Health Service; Centers for Disease Control and Prevention; National Center for Environmental Health; 1997.

O'Connor E, Rossom RC, Henninger M, Groom HC, Burda BU. Primary care screening for and treatment of depression in pregnant and post-partum women: evidence report and systematic review for the U.S. Preventive Services Task Force. JAMA. 2016;315(4):388-406.

Earls MF Committee on Psychosocial Aspects of Child and Family Health, American Academy of Pediatrics. Incorporating recognition and management of perinatal and postpartum depression into pediatric practice. Pediatrics. 2010;126(5):1032-1039.

Siu AL. Screening for depression in children and adolescents: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2016;164(5):360-366.

Weitzman C, Wegner L American Academy of Pediatrics Section on Developmental and Behavioral Pediatrics; Committee on Psychosocial Aspects of Child and Family Health; Council on Early Childhood; Society for Developmental and Behavioral Pediatrics; American Academy of Pediatrics. Promoting optimal development: screening for behavioral and emotional problems [published correction appears in Pediatrics . 2015;135(5):946]. Pediatrics. 2015;135(2):384-395.

Grossman DC, Curry SJ, Owens DK, et al. Vision screening in children aged 6 months to 5 years: U.S. Preventive Services Task Force recommendation statement. JAMA. 2017;318(9):836-844.

Donahue SP, Nixon CN Committee on Practice and Ambulatory Medicine, Section on Ophthalmology, American Academy of Pediatrics; American Association of Certified Orthoptists, American Association for Pediatric Ophthalmology and Strabismus, American Academy of Ophthalmology. Visual system assessment in infants, children, and young adults by pediatricians. Pediatrics. 2016;137(1):28-30.

Lin KW. What to do at well-child visits: the AAFP's perspective. Am Fam Physician. 2015;91(6):362-364.

American Academy of Pediatrics Council on Community Pediatrics. Poverty and child health in the United States. Pediatrics. 2016;137(4):e20160339.

Lavigne JV, Lebailly SA, Hopkins J, Gouze KR, Binns HJ. The prevalence of ADHD, ODD, depression, and anxiety in a community sample of 4-year-olds. J Clin Child Adolesc Psychol. 2009;38(3):315-328.

American Academy of Pediatrics Committee on Practice and Ambulatory Medicine, Section on Ophthalmology, American Association of Certified Orthoptists, American Association for Pediatric Ophthalmology and Strabismus, American Academy of Ophthalmology. Visual system assessment of infants, children, and young adults by pediatricians. Pediatrics. 2016;137(1):28-30.

American Academy of Family Physicians. Clinical preventive service recommendation. Immunizations. http://www.aafp.org/patient-care/clinical-recommendations/all/immunizations.html . Accessed October 5, 2017.

Centers for Disease Control and Prevention. Recommended immunization schedule for children and adolescents aged 18 years or younger, United States, 2018. https://www.cdc.gov/vaccines/schedules/hcp/child-adolescent.html . Accessed May 9, 2018.

National Center for Injury Prevention and Control. 10 leading causes of death by age group, United States—2015. https://www.cdc.gov/injury/images/lc-charts/leading_causes_of_death_age_group_2015_1050w740h.gif . Accessed April 24, 2017.

Durbin DR American Academy of Pediatrics Committee on Injury, Violence, and Poison Prevention. Child passenger safety. Pediatrics. 2011;127(4):788-793.

American Academy of Pediatrics Committee on Injury and Poison Prevention. Reducing the number of deaths and injuries from residential fires. Pediatrics. 2000;105(6):1355-1357.

Gardner HG American Academy of Pediatrics Committee on Injury, Violence, and Poison Prevention. Office-based counseling for unintentional injury prevention. Pediatrics. 2007;119(1):202-206.

American Academy of Pediatrics Committee on Injury, Violence, and Poison Prevention. Prevention of drowning in infants, children, and adolescents. Pediatrics. 2003;112(2):437-439.

American Academy of Pediatrics Committee on Injury and Poison Prevention. Injuries associated with infant walkers. Pediatrics. 2001;108(3):790-792.

American Academy of Pediatrics Committee on Injury and Poison Prevention. Falls from heights: windows, roofs, and balconies. Pediatrics. 2001;107(5):1188-1191.

Dowd MD, Sege RD Council on Injury, Violence, and Poison Prevention Executive Committee; American Academy of Pediatrics. Firearm-related injuries affecting the pediatric population. Pediatrics. 2012;130(5):e1416-e1423.

American Academy of Pediatrics Committee on Injury, Violence, and Poison Prevention. Prevention of choking among children. Pediatrics. 2010;125(3):601-607.

Kendrick D, Young B, Mason-Jones AJ, et al. Home safety education and provision of safety equipment for injury prevention (review). Evid Based Child Health. 2013;8(3):761-939.

American Academy of Pediatrics Section on Oral Health. Maintaining and improving the oral health of young children. Pediatrics. 2014;134(6):1224-1229.

Heyman MB, Abrams SA American Academy of Pediatrics Section on Gastroenterology, Hepatology, and Nutrition Committee on Nutrition. Fruit juice in infants, children, and adolescents: current recommendations. Pediatrics. 2017;139(6):e20170967.

Council on Communications and Media. Media and young minds. Pediatrics. 2016;138(5):e20162591.

Moon RY Task Force on Sudden Infant Death Syndrome. SIDS and other sleep-related infant deaths: evidence base for 2016 updated recommendations for a safe infant sleeping environment. Pediatrics. 2016;138(5):e20162940.

American Academy of Pediatrics Section on Breastfeeding. Breastfeeding and the use of human milk. Pediatrics. 2012;129(3):e827-e841.

Wagner CL, Greer FR American Academy of Pediatrics Section on Breastfeeding; Committee on Nutrition. Prevention of rickets and vitamin D deficiency in infants, children, and adolescents [published correction appears in Pediatrics . 2009;123(1):197]. Pediatrics. 2008;122(5):1142-1152.

Huh SY, Rifas-Shiman SL, Taveras EM, Oken E, Gillman MW. Timing of solid food introduction and risk of obesity in preschool-aged children. Pediatrics. 2011;127(3):e544-e551.

Greer FR, Sicherer SH, Burks AW American Academy of Pediatrics Committee on Nutrition; Section on Allergy and Immunology. Effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, timing of introduction of complementary foods, and hydrolyzed formulas. Pediatrics. 2008;121(1):183-191.

American Academy of Pediatrics Committee on Nutrition. The use of whole cow's milk in infancy. Pediatrics. 1992;89(6 pt 1):1105-1109.

Fleischer DM, Spergel JM, Assa'ad AH, Pongracic JA. Primary prevention of allergic disease through nutritional interventions. J Allergy Clin Immunol Pract. 2013;1(1):29-36.

Grossman DC, Bibbins-Domingo K, Curry SJ, et al. Screening for obesity in children and adolescents: U.S. Preventive Services Task Force recommendation statement. JAMA. 2017;317(23):2417-2426.

Daniels SR, Hassink SG Committee on Nutrition. The role of the pediatrician in primary prevention of obesity. Pediatrics. 2015;136(1):e275-e292.

American Academy of Family Physicians. Physical activity in children. https://www.aafp.org/about/policies/all/physical-activity.html . Accessed January 1, 2018.

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average cost of well child visit with insurance

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average cost of well child visit with insurance

AAP Schedule of Well-Child Care Visits

average cost of well child visit with insurance

Parents know who they should go to when their child is sick. But pediatrician visits are just as important for healthy children.

The Bright Futures /American Academy of Pediatrics (AAP) developed a set of comprehensive health guidelines for well-child care, known as the " periodicity schedule ." It is a schedule of screenings and assessments recommended at each well-child visit from infancy through adolescence.

Schedule of well-child visits

  • The first week visit (3 to 5 days old)
  • 1 month old
  • 2 months old
  • 4 months old
  • 6 months old
  • 9 months old
  • 12 months old
  • 15 months old
  • 18 months old
  • 2 years old (24 months)
  • 2 ½ years old (30 months)
  • 3 years old
  • 4 years old
  • 5 years old
  • 6 years old
  • 7 years old
  • 8 years old
  • 9 years old
  • 10 years old
  • 11 years old
  • 12 years old
  • 13 years old
  • 14 years old
  • 15 years old
  • 16 years old
  • 17 years old
  • 18 years old
  • 19 years old
  • 20 years old
  • 21 years old

The benefits of well-child visits

Prevention . Your child gets scheduled immunizations to prevent illness. You also can ask your pediatrician about nutrition and safety in the home and at school.

Tracking growth & development . See how much your child has grown in the time since your last visit, and talk with your doctor about your child's development. You can discuss your child's milestones, social behaviors and learning.

Raising any concerns . Make a list of topics you want to talk about with your child's pediatrician such as development, behavior, sleep, eating or getting along with other family members. Bring your top three to five questions or concerns with you to talk with your pediatrician at the start of the visit.

Team approach . Regular visits create strong, trustworthy relationships among pediatrician, parent and child. The AAP recommends well-child visits as a way for pediatricians and parents to serve the needs of children. This team approach helps develop optimal physical, mental and social health of a child.

More information

Back to School, Back to Doctor

Recommended Immunization Schedules

Milestones Matter: 10 to Watch for by Age 5

Your Child's Checkups

  • Bright Futures/AAP Recommendations for Preventive Pediatric Health Care (periodicity schedule)

The independent source for health policy research, polling, and news.

Preventive Services Covered by Private Health Plans under the Affordable Care Act

Published: Feb 28, 2024

Note:  This content was updated on February 28, 2024  to incorporate new FAQs from CMS. Tables 1 and 2 were also updated to include updated recommendations. It has been more than ten years since the Affordable Care Act (ACA) required private insurance plans to cover recommended preventive services without any patient cost-sharing. Research has shown that evidence-based preventive services can save lives and improve health by identifying illnesses earlier, managing them more effectively, and treating them before they develop into more complicated, debilitating conditions, and that some services are also cost-effective. Since the preventive services coverage policy went into effect, there have been numerous additions, changes, and updates to the policy as well as specific recommendations. There have also been legal challenges over elements of the preventive services requirement, including in the pending case, Braidwood Management Inc. v. Becerra . This fact sheet summarizes the federal requirements for coverage for preventive services in private plans, major updates to the requirement, and recent policy activities on this front.

ACA Requirements for Coverage of Preventive Services

Under Section 2713 of the ACA, private health plans must provide coverage for a range of recommended preventive services and may not impose cost-sharing (such as copayments, deductibles, or co-insurance) on patients receiving these services. 1 These requirements apply to all private plans—fully insured and self-insured plans in the individual, small group, and large group markets, except those that maintain “grandfathered” status. In 2019 , 13% of workers covered in employer sponsored plans were still in grandfathered plans. The requirements also apply to the Medicaid expansion eligibility pathway.

The required preventive services come from recommendations issued by four expert medical and scientific bodies—the U.S. Preventive Services Task Force (USPSTF), the Advisory Committee on Immunization Practices (ACIP), the Health Resources and Services Administration’s (HRSA’s) Bright Futures Project, and the HRSA-sponsored Women’s Preventive Services Initiative (WPSI). Individual and small group plans in the health insurance marketplaces are also required to cover an essential health benefit (EHB) package —that includes the full range of preventive requirements described in this fact sheet.

Clinical Preventive Services for Adults and Children

The ACA requires private plans to cover the following four broad categories of services for adults and children (summarized in Tables 1 and 2 ):

I. Evidence-Based Screenings and Counseling

Insurers must cover evidence-based services for adults that have a rating of “A” or “B” in the current recommendations of USPSTF , an independent panel of clinicians and scientists commissioned by the federal Agency for Healthcare Research and Quality. An “A” or “B” letter grade indicates that the panel finds there is high certainty that the services have a substantial or moderate net health benefit. The services required to be covered without cost-sharing include screenings for depression, diabetes, obesity, various cancers, and sexually transmitted infections (STIs), prenatal tests, medications that can help prevent HIV, breast cancer, and heart disease, as well as counseling for drug and tobacco use, healthy eating, and other common health concerns. The effective date for a new recommendation from USPSTF is considered to be the last day of the month in which it is published or otherwise released.

II. Routine Immunizations

Health plans must also provide coverage without cost-sharing for immunizations that are recommended and determined to be for routine use by the ACIP , a federal committee comprised of immunization experts that is convened by the Centers for Disease Control and Prevention (CDC). A new ACIP recommendation is considered to be issued on the date that it is adopted by the Director of the CDC. The preventive services guidelines require coverage for adults and children and include immunizations such as influenza, meningitis, tetanus, HPV, hepatitis A and B, measles, mumps, rubella, varicella, and COVID-19. With regard to the COVID-19 vaccine, Congress waived the typical one year delay in implementation and required private insurance plans to begin full coverage 15 days after ACIP recommendation. Going forward, any COVID-19 vaccine recommended by ACIP, including updated boosters, will continue to be fully covered for people enrolled in non-grandfathered plans starting 15 days after the vaccine is recommended by ACIP, irrespective of whether the vaccine is under an emergency use authorization or fully approved by the FDA.

III. Preventive Services for Women

In addition to the recommendations issued by USPSTF and ACIP, the ACA authorized HRSA to make coverage requirements for women for services not addressed by the other recommending bodies. HRSA turns to evidence-based recommendations issued by the Women’s Preventive Services Initiative (WPSI), to identify gaps in recommendations for women and review the evidence regarding the effectiveness of the recommendations. Current recommendations include well-woman visits, all FDA-approved, -granted, or -cleared contraceptives and related services, breastfeeding support and supplies, broader screening and counseling for a range of conditions, including intimate partner violence, urinary incontinence, anxiety, STIs and HIV. Some of the HRSA recommendations for women are similar to recommendations from USPSTF, but with slight variations in the population that is addressed.

Table 1 summarizes the full slate of adult preventive services subject to the preventive services coverage requirements.

IV. Preventive Services for Children and Youth

In addition to services for adults, the ACA requires that private plans cover without cost-sharing the preventive services recommended by the HRSA’s Bright Futures Project , which provides evidence-informed recommendations to improve the health and wellbeing of infants, children, and adolescents. The preventive services covered for children and adolescents include well child visits, immunization and screening services, behavioral and developmental assessments, fluoride supplements, and screening for autism, vision impairment, lipid disorders, tuberculosis, and certain genetic diseases. immunization and screening services, behavioral and developmental assessments, fluoride supplements, and screening for autism, vision impairment, lipid disorders, tuberculosis, and certain genetic diseases.

Table 2 summarizes the full slate of preventive services for children and adolescents.   

Coverage Rules and Clarifications

The recommending bodies periodically issue new recommendations and update existing ones based on advances in research. Plans are required to provide full coverage for new and updated recommendations one year after the latest issue date, beginning in the next plan year. 2 If a recommendation is changed during a plan year or a new recommendation is issued, an issuer is not required to make changes in the middle of the plan year, unless one of the recommending bodies determines that a service is discouraged because it is harmful or poses a significant safety concern. 3 In these circumstances, federal guidance will be issued. There are limited circumstances under which insurers may charge copayments and use other forms of cost-sharing for preventive services:

  • If the primary reason for the visit is not the preventive service, patients may have to pay for the office visit. For example, if an adult man sees a clinician for ongoing management of a chronic condition such as diabetes and also receives a COVID vaccine at that appointment, the plan may charge a co-payment for the office visit but may not charge for the vaccine, which is a recommended preventive service.
  • If the preventive service is performed by an out-of-network provider when an in-network provider is available to perform the service, insurers may charge patients for the office visit and the preventive service. However, if an out-of-network provider is used because there is no in-network provider able to provide the service then cost-sharing cannot be charged.
  • If a treatment is given as the result of a recommended preventive service, but is not the recommended preventive service itself, cost-sharing may be charged in some cases . For example, the USPSTF recommends a CT scan for some adults to screen for lung cancer. If cancer is detected during the scan, treatments such as surgery or medication may be prescribed. While plans must cover the screening test services in full, they may charge for the treatments.

The Public Health Service Act (PHSA) and federal regulations also allow plans to use “ reasonable medical management ” techniques to determine the frequency, method, treatment, or setting for a preventive item or service to the extent it is not specified in a recommendation or guideline. While there is no formal regulatory definition or parameters for reasonable medical management, medical management techniques are typically used by plans to control cost and utilization of care or comparable drug use. For example, plans can impose limits on number of visits or tests if unspecified by a recommendation, cover only generics or selected brands of pharmaceuticals, or require prior authorization to acquire a preferred brand drug. If a plan makes any material modifications that would affect the content of the plan’s Summary of Benefits and Coverage (SBC) during the plan year, the plan must notify enrollees of the change at least 60 days before it takes effect.

Since the policy took effect, a number of questions have arisen about how plans should implement the preventive services policy and the extent to which plans can use medical management practices to limit the frequency, range of covered services, and the types of providers that are subject to the policy. Over the years, the Departments of Health and Human Services, Labor, and Treasury have jointly issued a number of clarifications as” about different aspects of coverage of preventive services.

Notable highlights from clarifying documents include:

  • Colon cancer screening – USPSTF recommends screening for colorectal cancer in adults ages 45-75 using either stool-based testing or procedural screening, such as sigmoidoscopy or colonoscopy. There have been some cases of insured asymptomatic patients being charged unexpected cost-sharing for anesthesia and polyp removal during screening colonoscopies . The federal government has clarified multiple times that insurers must cover the full cost of medically necessary anesthesia services, polyp removal and related pathology performed in connection with a preventive colonoscopy in asymptomatic individuals, and follow up colonoscopies in the event of positive findings on stool-based tests, CT, or sigmoidoscopy.
  • Well-woman visits – The HRSA clinical preventive services for women include coverage for at least one well-woman preventive care visit for adult women. WPSI has clarified that a series of well-woma n visits may be required to fulfill all necessary preventive services and should be provided without cost-sharing as needed, determined by clinical expertise. Furthermore, the most recent recommendation states that prenatal visits are considered well woman visits, as are pre-pregnancy, postpartum, and interpartum visits WPSI has also published recommendations for services to be provided as part of well woman care.
  • Testing and medications for the risk reduction of breast cancer – Federal guidance reinforces the USPSTF recommendation that women with family history of breast, ovarian, or peritoneal cancer should be screened for BRCA-related cancer, and those with positive results should receive genetic counseling and testing without cost-sharing when the services are medically appropriate and recommended by her provider. USPSTF also recommends the provision of chemo-preventive medications, such as tamoxifen and raloxifene, for women who are at increased risk for breast cancer and at low risk for adverse effects.
  • Special populations – Some of the recommendations subject to the preventive services requirement apply to a certain population, such as “high risk” individuals. The government has clarified that it is up to the health care provider to determine whether a patient belongs to the population in consideration and that plans must cover services accordingly. An individual’s sex assigned at birth or gender identity also cannot limit them from a recommended preventive service that is medically appropriate for that individual; for example, a transgender man who has breast tissue or an intact cervix and meets other requirements for mammography or cervical cancer screening must receive those services without cost sharing regardless of sex at birth.
  • Contraceptive coverage – Contraceptive services and supplies for women is one of the recommendations from HRSA, and since it was first issued there have been numerous federal clarifications. Plans must cover without cost sharing at least one product within each FDA-approved, granted, or cleared contraceptive method for women as prescribed. In addition to covering the cost of the contraceptive supplies, plans must cover related counseling, insertion, removal, and follow up services. While insurers may use reasonable medical management to limit full coverage to generic drugs within a method category, federal clarifications also state that plans must cover any contraceptive if deemed “medically necessary” by a health care provider. This means that plans must cover the following: brand name drugs if a generic is not available, a clinician-recommended brand name product, and contraceptive products that are not specifically identified by HRSA, such as new contraceptive products approved by the FDA. Some plans may choose to cover only one product within a category of contraceptives that has other therapeutic equivalent products. If this is the case, the plan must have a process in place to make exceptions for an individual who want s to access a therapeutic equivalent product if it is determined to be medically necessary by the individual’s clinician .  Any “exceptions process” must be accessible and timely for patients and providers to request coverage for a medically necessary contraceptive.
  • Houses of worship have always been exempted from the contraceptive requirement, and religiously affiliated nonprofit employers have had an accommodation if they have a religious objection to contraceptives. Some employers have challenged this regulation, claiming the accommodation offered by the government (where the method is covered by their plan but they are not required to pay towards its coverage as part of the premium) makes them complicit in the provision of contraception, a service they object to on religious or moral grounds. The federal policy regarding contraceptive coverage requirements for employer plans has undergone multiple changes in federal regulations and been contested in numerous legal cases, including three that reached the Supreme Court. The current regulations were issued during the Trump Administration and exempt nearly any employer that claims to have a religious or moral objection from providing contraceptive coverage.
  • Coverage for HIV Preexposure Prophylaxis (PrEP) – In June 2019, PrEP, medications which can help prevent HIV, received an “A”’ grade recommendation from the USPSTF as “effective antiretroviral therapy to persons who are at high risk of HIV acquisition.” Plans or policy years beginning on or after June 30, 2020, must cover PrEP (consistent with the USPSTF recommendation) without cost sharing. Federal guidance clarified that plans and insurers must also cover ancillary and support services for PrEP, such as adherence counseling and risk-reduction strategies, without cost sharing, and cannot use reasonable medical management techniques to restrict access to these services.

Impact of the Preventive Services Rules

The federal HHS Assistant Secretary for Planning and Evaluation (ASPE) estimates that in 2020, approximately 151.6 million people (58 million women, 57 million men, and 37 million children) currently are enrolled in non-grandfathered private health insurance plans that cover preventive services with no-cost sharing. Research has documented the impact of the policy on access to care in some areas, including utilization of cancer screening and contraceptives.

The evidence on cancer screening utilization after the elimination of cost-sharing is mixed and varies by cancer type. Some studies have shown that while screening rates for colorectal cancer among privately insured individuals increased since the passage of the ACA, rates for Pap testing decreased . However, it is difficult to assess the impact of the coverage provision since the recommendations for cervical cancer screening have been revised since the policy went into effect. Screening rates for breast cancer remained stable, though one study found that mammography screening among African American women significantly increased after ACA implementation. Likewise, the elimination of cost-sharing is associated with increases in BRCA genetic testing which helps identify women who are at elevated risk for breast and ovarian cancer. Studies have also indicated that increased access to and affordability of preventive services has helped cancer survivors obtain necessary care.

Several studies found that the contraceptive coverage requirement under the ACA has dramatically reduced OOP spending for contraceptives, including OOP spending for oral contraceptives (Figure 2). Multiple studies have shown increases in utilization for short-term birth control methods such as birth control pills, patches, and diaphragms. Studies have found that utilization of long-acting reversible contraceptives (LARCs), such as intrauterine devices (IUDs) and implants, increased after ACA implementation. Additional research also shows that OOP costs for LARCs —some of the most effective forms of pregnancy prevention—were also reduced under the ACA. These findings suggest that the lowered OOP costs from the contraceptive coverage requirement has improved contraception use and adherence .

The preventive services coverage policy has become an established part of health coverage for most people in the United States. Yet, the policy is currently facing legal challenges, notably in the case Braidwood Management Inc v. Becerra. The outcome of the latest legal challenge could affect whether people will continue to have full no-cost coverage for recommended preventive services in the future.

Note that the rules described in this fact sheet apply to private insurers, self-insured employer plans, and are separate from preventive requirements for public programs like Medicare or Medicaid.

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The final issue date for new or updated recommendations varies by recommending body. Recommendations are considered to be issued on the last day of the month on which the USPSTF publishes or releases the recommendation; recommendations from ACIP are considered issued on the date it is adopted by the Director of the CDC; and a recommendation or guideline supported by HRSA is considered to be issued on the date on which it is accepted by the Administrator of HRSA or, if applicable, adopted by the Secretary of HHS. Federal Register, Vol. 80, NO. 134, July 14, 2015.

These circumstances include downgrade of a USPSTF service from a rating of “A” or “B” to “D” (which means that USPTF has determined that there is strong evidence that there is no net benefit, or that the harms outweigh the benefits, and therefore discourages the use of this service), or a service is the subject of a safety recall or otherwise determined to pose a significant safety concern by a federal agency authorized to regulate that item or service.

  • Women's Health Policy
  • Affordable Care Act
  • Private Insurance
  • Cost Sharing

Also of Interest

  • Preventive Services Tracker
  • Preventive Services for Women Covered by Private Health Plans under the Affordable Care Act

Doctor Visits

Make the Most of Your Baby’s Visit to the Doctor (Ages 0 to 11 Months)

A smiling doctor helps a healthy baby sit up for an exam.

Take Action

Babies need to go to the doctor or nurse for a “well-baby visit” 6 times before their first birthday.

A well-baby visit is when you take your baby to the doctor to make sure they’re healthy and developing normally. This is different from other visits for sickness or injury.

At a well-baby visit, the doctor or nurse can help catch any problems early, when they may be easier to treat. You’ll also have a chance to ask any questions you have about caring for your baby.

Learn what to expect so you can make the most of each well-baby visit.

Well-Baby Visits

How often do i need to take my baby for well-baby visits.

Babies need to see the doctor or nurse 6 times before their first birthday. Your baby is growing and changing quickly, so regular visits are important.

The first well-baby visit is 2 to 3 days after coming home from the hospital, when the baby is about 3 to 5 days old. After that first visit, babies need to see the doctor or nurse when they’re:

  • 1 month old
  • 2 months old
  • 4 months old
  • 6 months old
  • 9 months old

If you’re worried about your baby’s health, don’t wait until the next scheduled visit — call the doctor or nurse right away.

Child Development

How do i know if my baby is growing and developing on schedule.

Your baby’s doctor or nurse can help you understand how your baby is developing and learning to do new things — like smile or turn their head to hear your voice. These are sometimes called “developmental milestones.”

At each visit, the doctor or nurse will ask you how you’re doing as a parent and what new things your baby is learning to do. 

By age 2 months, most babies:

  • Lift their head when lying on their stomach
  • Look at your face
  • Smile when you talk to them
  • React to loud sounds

See a complete list of milestones for kids age 2 months .

By age 4 months, most babies:

  • Bring their hands to their mouth
  • Make cooing sounds
  • Hold toys that you put in their hand
  • Turn their head to the sound of your voice
  • Make sounds when you talk to them

See a complete list of milestones for kids age 4 months .

By age 6 months, most babies:

  • Lean on their hands for support when sitting
  • Roll over from their stomach to their back
  • Show interest in and reach for objects
  • Recognize familiar people
  • Like to look at themselves in a mirror

See a complete list of milestones for kids age 6 months . 

By age 9 months, most babies:

  • Make different sounds like “mamamama” and “bababababa”
  • Smile or laugh when you play peek-a-boo
  • Look at you when you say their name
  • Sit without support

See a complete list of milestones for kids age 9 months . 

What if I'm worried about my baby's development? 

Remember, every baby develops a little differently. But if you’re concerned about your child’s growth and development, talk to your baby’s doctor or nurse. 

Learn more about newborn and infant development .

Take these steps to help you and your baby get the most out of well-baby visits.

Gather important information.

Take any medical records you have to the appointment, including a record of vaccines (shots) your baby has received and results from newborn screenings . Read about newborn screenings .

Make a list of any important changes in your baby’s life since the last doctor’s visit, like:

  • Falling or getting injured
  • Starting daycare or getting a new caregiver

Use this tool to  keep track of your baby’s family health history .

What about cost?

Under the Affordable Care Act, insurance plans must cover well-child visits. Depending on your insurance plan, you may be able to get well-child visits at no cost to you. Check with your insurance company to find out more.

Your child may also qualify for free or low-cost health insurance through Medicaid or the Children’s Health Insurance Program (CHIP). Learn about coverage options for your family.

If you don’t have insurance, you may still be able to get free or low-cost well-child visits. Find a health center near you and ask about well-child visits.

To learn more, check out these resources:

  • Free preventive care for children covered by the Affordable Care Act
  • How the Affordable Care Act protects you and your family
  • Understanding your health insurance and how to use it [PDF - 698 KB]

Ask Questions

Make a list of questions to ask the doctor..

Before the well-baby visit, write down 3 to 5 questions you have. Each well-baby visit is a great time to ask the doctor or nurse any questions about:

  • How your baby is growing and developing
  • How your baby is sleeping
  • Breastfeeding your baby
  • When and how to start giving your baby solid foods
  • What changes and behaviors to expect in the coming months
  • How to make sure your home is safe for a growing baby

Here are some questions you may want to ask:

  • Is my baby up to date on vaccines?
  • How can I make sure my baby is getting enough to eat?
  • Is my baby at a healthy weight?
  • How can I make sure my baby is sleeping safely — and getting enough sleep?
  • How can I help my baby develop speech and language skills?
  • Is it okay for my baby to have screen time?
  • How do I clean my baby's teeth?

Take a notepad, smartphone, or tablet and write down the answers so you can remember them later.

Ask what to do if your baby gets sick.

Make sure you know how to get in touch with a doctor or nurse when the office is closed. Ask how to reach the doctor on call, or if there's a nurse information service you can call at night or on the weekend.

What to Expect

Know what to expect..

During each well-baby visit, the doctor or nurse will ask you about your baby and do a physical exam. The doctor or nurse will then update your baby’s medical history with all of this information.

The doctor or nurse will ask questions about your baby.

The doctor or nurse may ask about:

  • Behavior — Does your baby copy your movements and sounds?
  • Health — How many diapers does your baby wet each day? Does your baby spend time around people who are smoking or using e-cigarettes (vaping)?
  • Safety — If you live in an older home, has it been inspected for lead? Do you have a safe car seat for your baby?
  • Activities — Does your baby try to roll over? How often do you read to your baby?
  • Eating habits — How often does your baby eat each day? How are you feeding your baby?
  • Family — Do you have any worries about being a parent? Who can you count on to help you take care of your baby?

Your answers to questions like these will help the doctor or nurse make sure your baby is healthy, safe, and developing normally.

Physical Exam

The doctor or nurse will also check your baby’s body..

To check your baby’s body, the doctor or nurse will:

  • Measure height, weight, and the size of your baby’s head
  • Take your baby’s temperature
  • Check your baby’s eyes and hearing
  • Check your baby’s body parts (this is called a physical exam)
  • Give your baby shots they need

Learn more about your baby’s health care:

  • Read about what to expect at your baby’s first checkups
  • Find out how to get your baby’s shots on schedule

Content last updated March 30, 2023

Reviewer Information

This information on well-baby visits was adapted from materials from the Centers for Disease Control and Prevention and the National Institutes of Health.

Reviewed by: Sara Kinsman, M.D., Ph.D. Director, Division of Child, Adolescent, and Family Health Maternal and Child Health Bureau Health Resources and Services Administration

Bethany Miller, M.S.W. Chief, Adolescent Health Branch Maternal and Child Health Bureau Health Resources and Services Administration

Diane Pilkey, R.N., M.P.H. Nursing Consultant, Division of Child, Adolescent, and Family Health Maternal and Child Health Bureau Health Resources and Services Administration

September 2021

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Trends in Well-Child Visits With Out-of-Pocket Costs in the US Before and After the Affordable Care Act

Paul r. shafer.

1 Department of Health Law, Policy, and Management, School of Public Health, Boston University, Boston, Massachusetts

Alex Hoagland

2 Department of Economics, College of Arts and Sciences, Boston University, Boston, Massachusetts

Heather E. Hsu

3 Department of Pediatrics, School of Medicine, Boston University, Boston, Massachusetts

Accepted for Publication: January 20, 2021.

Published: March 12, 2021. doi:10.1001/jamanetworkopen.2021.1248

Open Access: This is an open access article distributed under the terms of the CC-BY License . © 2021 Shafer PR et al. JAMA Network Open .

Author Contributions : Dr Shafer and Mr Hoagland had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Shafer.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Shafer, Hoagland.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Shafer, Hoagland.

Administrative, technical, or material support: Hoagland.

Supervision: Shafer.

Conflict of Interest Disclosures: Mr Hoagland reported receiving a Student Summer Research Award from the Boston University Institute for Health System Innovation and Policy. No other disclosures were reported.

This cross-sectional study uses national claims data to assess trends in well-child care visits with out-of-pocket costs before and after passage of the Affordable Care Act.

Introduction

In the US, both Medicaid and the Children’s Health Insurance Program exclude well-child care from cost sharing, but out-of-pocket costs present a barrier to accessing preventive services for privately insured children. 1 The promised elimination of these costs is a popular provision of the Affordable Care Act (ACA). Although the proportion of well-child visits with out-of-pocket costs declined from 73% before passage of the ACA to 49% in 2011 and 2012, 2 the evolution of trends in out-of-pocket costs is unknown. We used national claims data to describe cross-sectional trends in well-child visits with out-of-pocket costs from 2006 through 2018.

This cross-sectional study was deemed exempt from review, and the requirement for patient written informed consent was waived by the Boston University Institutional Review Board because deidentified data were used. We followed the Strengthening the Reporting of Observational Studies in Epidemiology ( STROBE ) reporting guideline. We used health insurance claims from 2006 through 2018 from children aged 0 to 17 years with full-year coverage each year; claims were obtained from the IBM MarketScan Commercial Claims and Encounters Database. 3

We focused on 2 outcomes: the proportion of children who had an office or outpatient visit without a wellness visit and the proportion of wellness visits resulting in an out-of-pocket cost, which were calculated annually during the study period. We stratified the sample by 2 age groups (0 to 5 years and 6 to 17 years) because these groups have a different recommended frequency of visits for wellness and other preventive services. 4 Diagnosis codes from the International Classification of Diseases, Ninth Revision (visits before October 2015) and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (visits in October 2015 and after) and Current Procedural Terminology and Healthcare Common Procedure Coding System codes used to identify preventive services were obtained from the Centers for Disease Control and Prevention and were supplemented with coding guidelines from major insurers. 5

We examined trends in visit volumes to ensure that compositional changes did not explain the findings and assessed the delivery of preventive services during non-wellness visits. We plotted the trends over time and tested for significance using linear regression. P  < .05 was considered to be statistically significant, all P values were 2-sided. Data were analyzed from June 10, 2020, to January 15, 2021, using SAS, version 9.4 (SAS Institute, Inc) and Stata, version 16 (StataCorp).

The sample consists of 88 863 727 person-years from privately insured children in 48 states, with a total of 371 573 184 visits across the study period from 2006 through 2018 ( Table ). The mean (SD) age of participants was 9.19 (5.09) years, and 15 945 616 of 31 247 534 participants were male (51.03%). The proportion of children with at least 1 office or outpatient visit and without a wellness visit declined from 39.3% in 2006 to 29.0% by 2018 (coefficient on linear time trend: −0.79 percentage points; 95% CI, −1.11 to −0.47; P  < .001) ( Figure , A). The volume and relative share of total visits per child (coefficient on linear time trend: 0.01 visits; 95% CI, 0.01-0.02; P  = .03) and wellness visits per child (coefficient on linear time trend: 0.02 visits; 95% CI, 0.01-0.02; P  < .001) remained stable over time ( Figure , B). Older children had office visits or outpatient care without a wellness visit at higher rates than younger children during the study period ( Figure , A). The percentage of wellness visits with an associated out-of-pocket cost declined from 54.2% in 2010 (the year that the ACA was passed) to 14.5% in 2018 (coefficient on linear time trend: −5.63 percentage points; 95% CI −6.96 to −4.31; P  < .001) ( Figure , C). In addition, the percentage of non-wellness visits with associated preventive services increased approximately 60%, from 1.8% in 2006 to 3.7% in 2018 (coefficient on linear time trend: 0.09 percentage points; 95% CI, 0.03-0.15; P  = .005).

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Object name is jamanetwopen-e211248-g001.jpg

Out-of-pocket costs included costs associated with procedures (eg, laboratory tests, immunizations) that occurred on the same day as the wellness visit in addition to any charges for the visit itself. ACA indicates Affordable Care Act; ICD-10-CM , International Statistical Classification of Diseases, Tenth Revision, Clinical Modification .

Following passage of the ACA, engagement of privately insured children in well-child care increased and the proportion of families incurring out-of-pocket costs for this care declined. However, approximately 1 of 7 wellness visits still results in out-of-pocket costs. Delivery of preventive services is increasing during non-wellness visits, indicating that providers may be encouraging prevention at any opportunity. This study is limited because specific insurers were not analyzed; however, there is considerable overlap in preventive coding guidelines, and we believe that our coding scheme is inclusive of federal guidance and several major insurers. There are several reasons why parents still receive unexpected bills for well-child care but the continued decline in costs as a barrier is encouraging. 6

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Home > Finance > How Much Does A Pediatrician Visit Cost Without Insurance

How Much Does A Pediatrician Visit Cost Without Insurance

How Much Does A Pediatrician Visit Cost Without Insurance

Published: November 23, 2023

Without insurance, the cost of a pediatrician visit can vary. Learn about the different factors that can impact the price and find ways to manage your finances effectively.

(Many of the links in this article redirect to a specific reviewed product. Your purchase of these products through affiliate links helps to generate commission for LiveWell, at no extra cost. Learn more )

Table of Contents

Introduction, understanding pediatrician visits, factors affecting the cost of pediatrician visits, average cost of pediatrician visits without insurance, ways to reduce the cost of pediatrician visits without insurance, free and low-cost options for pediatrician visits.

When it comes to taking care of our children’s health, regular visits to a pediatrician are crucial. However, not everyone has the luxury of health insurance coverage to offset the costs associated with these visits. That’s why it’s essential to understand how much a pediatrician visit may cost without insurance.

A pediatrician is a specialized doctor who provides medical care for infants, children, and adolescents. These visits involve routine check-ups, immunizations, developmental assessments, and addressing any concerns parents may have about their child’s health. While the primary focus is on the well-being of the child, the financial aspect cannot be overlooked.

The cost of a pediatrician visit without insurance can vary significantly depending on various factors such as the location, services provided, and the specific needs of the patient. Understanding these factors can help parents better navigate the financial aspect of pediatrician visits and plan accordingly.

In this article, we will delve into the factors that influence the cost of pediatrician visits without insurance, explore the average costs, and discuss ways to reduce the financial burden. We will also touch on free and low-cost options available for families facing financial constraints.

It’s important to note that while this article provides general information, the actual costs can vary, and it is always advisable to consult with a pediatrician or healthcare provider for accurate and up-to-date information.

Now, let’s dive deeper into the world of pediatrician visits and understand how much they may cost without insurance coverage.

Pediatrician visits are an essential aspect of a child’s healthcare journey. These visits serve several purposes, including preventive care, assessing growth and development, addressing health concerns, and providing necessary vaccinations. By understanding the different aspects of pediatrician visits, parents can ensure their child receives comprehensive healthcare.

Preventive care is a key component of pediatrician visits. Regular check-ups, often referred to as well-child visits, are scheduled at various intervals, starting from infancy and continuing through adolescence. These visits allow the pediatrician to monitor the child’s growth and development, assess their overall health status, conduct routine screenings, and provide guidance on nutrition, safety, and age-appropriate activities.

During pediatrician visits, developmental assessments are conducted to track the child’s milestones, such as cognitive, motor, and social-emotional development. This enables the pediatrician to identify any potential delays or concerns and provide appropriate interventions or referrals to specialists if necessary.

Immunizations are another important aspect of pediatrician visits. These vaccinations protect children against various diseases and help maintain community immunity. The pediatrician will administer vaccines according to the recommended schedule, ensuring that the child is up to date with the necessary immunizations.

In addition to preventive care, pediatrician visits address any health concerns or issues that parents may have about their child’s physical or emotional well-being. This can include acute illnesses, chronic conditions, allergies, behavioral concerns, or any other medical issues that may arise. The pediatrician will conduct examinations, order tests if needed, and provide appropriate treatment or referrals to specialists.

Overall, pediatrician visits play a vital role in promoting and maintaining children’s health and well-being. By establishing a strong relationship with a pediatrician, parents can ensure that their child receives comprehensive medical care, guidance, and support throughout their development.

In the next section, we will explore the factors that can influence the cost of pediatrician visits without insurance.

The cost of pediatrician visits without insurance can vary depending on several factors. Understanding these factors can help parents anticipate and plan for the expenses associated with their child’s medical care. Here are some key factors that can influence the cost of pediatrician visits:

  • Location: The geographical location plays a significant role in determining the cost of pediatrician visits. In areas with a higher cost of living, such as major cities, the fees may be higher compared to smaller towns or rural areas. It’s important to research and compare the rates of pediatricians in your specific location to get an idea of the expected costs.
  • Type of Visit: The purpose of the visit can also affect the cost. Routine well-child visits, which include preventive care and developmental assessments, may have a different price range compared to visits for acute illnesses or specialized consultations. The complexity and duration of the visit can impact the overall cost.
  • Services Provided: Pediatrician visits may encompass a range of services, from physical examinations and vaccinations to laboratory tests and screenings. The cost may differ depending on the specific services provided during the visit. For example, additional tests or procedures may incur extra charges.
  • Additional Services: In some cases, pediatricians may offer additional services or procedures not covered by insurance, such as certain types of counseling or specialized treatments. These services may come at an additional cost, so it’s important to discuss and understand what is included in the visit and any potential extra charges.
  • Experience and Reputation: Pediatricians with extensive experience and a strong reputation in their field may charge higher fees for their services. The level of expertise and recognition can impact the cost of pediatrician visits. However, it’s essential to consider the quality of care and the relationship with the pediatrician when evaluating the value of their services.

It’s important to note that these factors are not exhaustive, and the cost of pediatrician visits can vary from practice to practice. The best way to determine the specific cost of pediatrician visits without insurance is to contact the pediatrician’s office directly and inquire about their fees and any additional expenses that may be incurred.

Now that we understand the factors influencing the cost of pediatrician visits, let’s explore the average costs parents can expect to encounter without insurance coverage in the next section.

While the cost of pediatrician visits without insurance can vary, it’s helpful to have a general understanding of the average expenses you may encounter. Keep in mind that these numbers are approximate and can differ based on the factors discussed earlier.

A routine well-child visit, which includes a comprehensive examination, developmental assessment, and immunizations, can cost anywhere from $100 to $300 without insurance. The cost may be higher for initial visits or visits that involve additional screenings or specialized consultations.

Visits for acute illnesses or specific concerns may have different price ranges. For example, a visit to address a common illness like the flu or a minor injury may range from $75 to $150 without insurance. However, if the visit requires additional tests or treatments, the cost can increase accordingly.

It’s important to note that these costs are for the pediatrician’s services only and do not include any additional costs such as laboratory tests, X-rays, or medications. These additional expenses can further contribute to the overall cost of the visit.

It’s worth mentioning that some pediatricians offer discounted rates or payment plans for uninsured patients, so it’s helpful to inquire about any available options when scheduling an appointment. Additionally, some practices may have a sliding fee scale based on income for families who meet specific criteria.

Now that we have a general idea of the average costs, let’s explore some strategies to help reduce the financial burden of pediatrician visits without insurance in the next section.

While the cost of pediatrician visits without insurance can be a financial burden, there are several strategies that parents can employ to help reduce these expenses. Here are some ways to mitigate the costs and make pediatrician visits more affordable:

  • Shop around: Research and compare the rates of different pediatricians in your area. Look for practices that offer competitive pricing without compromising the quality of care. Additionally, inquire about any discounts or payment plans that may be available for uninsured patients.
  • Consider telemedicine: Telemedicine services have gained popularity in recent years, allowing remote consultations with healthcare providers. Some pediatricians offer virtual visits, which can be a more cost-effective option compared to in-person visits. This can be particularly useful for minor illnesses or follow-up consultations.
  • Utilize community health clinics: Community health clinics often provide low-cost or free pediatric services to families in need. These clinics may offer comprehensive well-child visits, vaccinations, and basic medical care at reduced rates. Research local community clinics in your area and determine if you qualify for their services.
  • Explore government assistance programs: Depending on your income level and eligibility criteria, you may qualify for government assistance programs that provide healthcare coverage for children. Programs such as Medicaid or the Children’s Health Insurance Program (CHIP) can help offset the costs of pediatrician visits and other medical expenses. Check if you meet the requirements to enroll in these programs.
  • Ask for itemized billing: When receiving the bill for a pediatrician visit, ask for an itemized breakdown of the charges. This will help you understand the specific services provided and allow you to identify any potential errors or unnecessary charges that can be addressed.
  • Negotiate payment plans: If you are facing financial limitations, communicate with your pediatrician’s office and explore the option of setting up a payment plan. Many healthcare providers are willing to work with patients to establish affordable payment arrangements over time.
  • Consider healthcare savings accounts: Healthcare savings accounts, such as Health Savings Accounts (HSAs) or Flexible Spending Accounts (FSAs), allow you to set aside pre-tax money specifically for medical expenses. By utilizing these accounts, you can allocate funds for pediatrician visits and reduce the financial burden.

It’s important to proactively communicate with your pediatrician and be open about your financial situation. They may have additional resources or recommendations to help you navigate the cost of pediatrician visits.

Now, let’s explore some free and low-cost options available for families facing financial constraints.

Families facing financial constraints can still access pediatrician visits through various free and low-cost options. These resources ensure that children receive the necessary medical care regardless of their financial situation. Here are some options to consider:

  • Community health clinics: As mentioned earlier, community health clinics often provide pediatric services at reduced rates or even for free. These clinics prioritize serving low-income individuals and families and offer comprehensive healthcare, including well-child visits, vaccinations, and basic medical care. Contact local clinics or use online directories to find community health centers in your area.
  • School-based health centers: Many schools have health centers on their premises that offer medical services to students. These centers often have pediatricians or nurse practitioners available to provide healthcare, including routine check-ups and evaluations. If your child attends a school with a health center, it can be a convenient and affordable option for pediatrician visits.
  • Government assistance programs: Government programs, such as Medicaid or the Children’s Health Insurance Program (CHIP), provide healthcare coverage for eligible children from low-income families. These programs offer comprehensive medical services, including pediatrician visits, at little to no cost. Check if you meet the criteria to enroll your child in these programs and access the benefits they provide.
  • Non-profit organizations: Some non-profit organizations and charities focus on improving access to healthcare for children in need. They may offer free or low-cost pediatrician visits or collaborate with healthcare providers to provide subsidized services. Research local non-profit organizations that focus on children’s healthcare and inquire about their available resources.
  • Teaching hospitals and medical schools: Teaching hospitals and medical schools often provide pediatric services at reduced rates. These institutions train medical students, residents, and fellows, who can offer care under the supervision of experienced physicians. While the cost is typically lower in these settings, the quality of care remains high. Contact teaching hospitals or medical schools in your area to inquire about their pediatric services.
  • Wellness programs and health fairs: Many communities organize wellness programs and health fairs that include free or low-cost healthcare services, including pediatrician visits. These events often collaborate with healthcare providers to offer medical check-ups, vaccinations, and health education. Stay informed about such programs in your community and take advantage of the available services.

Remember to research and reach out to these resources in advance to determine their availability, eligibility criteria, and any necessary documentation you may need to bring with you. These options can help ensure that your child receives the medical care they need without placing a significant financial burden on your family.

Now, let’s conclude our discussion on the cost of pediatrician visits without insurance.

Regular pediatrician visits are essential for the health and well-being of children, but the cost can be a concern for families without insurance coverage. Understanding the factors that influence the cost of pediatrician visits, such as location, type of visit, and services provided, can help parents anticipate expenses and plan accordingly.

The average cost of pediatrician visits without insurance can range from $100 to $300 for routine well-child visits, while visits for acute illnesses or specialized consultations may have different price ranges. It’s important to keep in mind that additional costs for laboratory tests, medications, and procedures can further contribute to the overall expenses.

There are several ways to reduce the cost of pediatrician visits without insurance. Shopping around, considering telemedicine, utilizing community health clinics, exploring government assistance programs, and negotiating payment plans are all strategies that can help alleviate the financial burden. Additionally, healthcare savings accounts can provide a means to set aside funds specifically for medical expenses.

For families facing financial constraints, free and low-cost options are available to access pediatrician visits. Community health clinics, school-based health centers, government assistance programs, non-profit organizations, teaching hospitals, and wellness programs can provide pediatric services at reduced rates or even for free.

While this article provides general information, it’s important to consult with a pediatrician or healthcare provider to get accurate and up-to-date cost details for pediatrician visits without insurance. They can provide personalized information based on your specific situation.

Remember, the well-being of your child should be a top priority, and there are resources available to ensure they receive the necessary medical care, even without insurance coverage. By taking proactive steps to manage the costs, you can provide your child with the healthcare they need while minimizing the financial impact on your family.

Now that you have a better understanding of the cost considerations and available options, you can approach pediatrician visits with confidence, knowing that there are ways to make it more manageable for your family.

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Well child visit vs Office Visit – What is the difference and why do I need to know?

A well-child visit , also known as a preventive visit or check-up, is an appointment made to assess a child’s overall health and well-being. These visits may include screenings, immunizations, and other preventative measures.

An office visit, on the other hand, refers to an appointment made with a healthcare provider for any reason, including diagnosis and treatment of illnesses or injuries, and follow-up care.

Well-child visits are typically more focused on preventive care and are less likely to involve a problem focused examination or treatment of a specific condition. Office visits can be for preventive care, but they can also be for the evaluation of a specific health concern or for follow-up care after a previous visit. Most insurance plans do not cover the diagnosis and treatment of specific problems during a preventive visit.

average cost of well child visit with insurance

As upsetting and frustrating as it may sound to have to schedule two separate appointments with your healthcare provider for your child’s preventive visit and another for a specific concern that you may have about your child, this is usually not your provider’s fault. This is mostly because your provider may not be able to address your concern in the time allotted for your child’s preventive visit and also because most insurance companies will not cover both preventive and office visit at the same time. If you insist that your provider addresses your concern during the preventive visit, you may end up incurring a bill you did not plan for.

In summary, the specifics of a policy for well-child visits and office visits can vary depending on the healthcare provider or insurance plan. Some insurance plans may cover preventive visits and sick visits at no cost to the patient, while others may require a copay or have certain limitations on coverage. It is important to check with your provider or insurance plan to understand the specifics of their policy on well-child visits and office visits. This can help you determine what types of preventive care and treatment are covered, how often you can schedule visits, and any costs associated with these visits.

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What to Expect the First Year , 3rd edition, Heidi Murkoff. WhatToExpect.com,  Your Baby's Vaccine Schedule: What Shots Should Your Child Get When? , January 2021. American Academy of Pediatrics, AAP Schedule of Well-Child Care Visits , September 2021. American Academy of Pediatrics, Checkup Checklist: 1 Month Old , September 2021. KidsHealth From Nemours,  Your Child's Checkup: 1 Month , April 2021.

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Insurance Status of Georgia's 2003 Birth Cohort

Calculation of costs by plan type, relationship between oop costs and immunization coverage, conclusions, acknowledgement, out-of-pocket costs of childhood immunizations: a comparison by type of insurance plan.

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Noëlle-Angélique M. Molinari , Maureen Kolasa , Mark L. Messonnier , Richard A. Schieber; Out-of-Pocket Costs of Childhood Immunizations: A Comparison by Type of Insurance Plan. Pediatrics November 2007; 120 (5): e1148–e1156. 10.1542/peds.2006-3654

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BACKGROUND. The “Guide to Community Preventive Services” strongly recommends reducing out-of-pocket costs to increase vaccination rates among children. Nevertheless, out-of-pocket expenses are still incurred during the receipt of childhood vaccines, vaccine administration, and associated well-child visits.

OBJECTIVE. Our goal was to estimate total and out-of-pocket costs of childhood immunization.

METHODS. We used the 2003 benefit-plan data for all 1217 private and public health plans registered in Georgia and the 2003 Advisory Committee on Immunization Practices recommended vaccine schedule to calculate costs to vaccinate children aged 0 to 5 years in 2003 dollars. By applying published estimates of health insurance enrollment of Georgia children, we calculated the total and out-of-pocket costs per child according to insurance status and race/ethnicity. Immunization coverage according to payer type was based on National Immunization Survey data.

RESULTS. Out-of-pocket costs ranged between $0 (Medicaid/Peachcare) and $652 (uninsured/Medicare). Most out-of-pocket costs were incurred during the first year of life. Up-to-date immunization status ranged from 63.7% for uninsured persons to 83.2% for privately insured persons. Up-to-date status was negatively correlated with out-of-pocket costs and the proportion of the population below 250% of the federal poverty level.

CONCLUSIONS. For most Georgia families, out-of-pocket expenses for childhood immunizations were low, favoring compliance with the recommended immunization schedule. However, families least able to afford the expense faced disproportionately high out-of-pocket costs. Out-of-pocket costs were inversely correlated with immunization coverage levels. Uninsured children whose families lived below 250% of the federal poverty level experienced the lowest immunization coverage levels. Immunization coverage through the Vaccines for Children Program and Medicaid/State Children's Health Insurance Programs should be promoted to minimize or eliminate out-of-pocket costs related to childhood immunizations, especially among children of low-income families.

Reducing out-of-pocket (OOP) costs is 1 evidence-based strategy that is strongly recommended by the “Guide to Community Preventive Services” to increase vaccination rates among children. 1 – 3   In 2003, the Advisory Committee on Immunization Practices recommended 23 immunizations for children before their fifth birthday, to be administered over 7 visits. 4   Routine surveillance of 19- to 35-month-old children in the general US population in 2003 indicated that vaccination coverage for the 4:3:1:3:3 immunization series (≥4 doses of diphtheria, tetanus, and acellular pertussis vaccines, ≥3 doses of poliovirus vaccine, ≥1 dose of measles, mumps, and rubella vaccine, ≥3 doses of Haemophilus influenzae type b vaccine, and ≥3 doses of hepatitis B vaccine) was 79.4% (95% confidence interval [CI]: 78.5–80.3), with state means ranging between 67.5% and 94.0%. 5  

The total cost of each vaccine has 3 separate additive components: the cost of the vaccine itself, the cost of its administration by a health care provider, and the cost of a concomitant well-child examination. The US Vaccines for Children (VFC) program provides the vaccine free of charge to qualified children but does not cover the cost of vaccine administration or well-child examination. 6   The latter 2 represent OOP expenses typically paid by the parent at the point of service. Although Medicaid-insured children face little or no OOP expense, privately insured children also incur OOP expenses in the form of copayments for 1 or more components.

The Task Force on Community Preventive Services first published its recommendation to reduce OOP costs for childhood immunizations in 1999. 7   However, neither the studies systematically reviewed by the task force nor those published since then provide an estimate of OOP costs of the childhood vaccination schedule, for a general population or by payer type. 8 , 9   Accordingly, our purpose was to (1) estimate OOP costs of childhood vaccination for children aged 0 to 5 years for a defined general population, Georgia's 2003 birth cohort, stratified by type of insurance coverage and race/ethnicity and (2) determine the extent of any association between OOP and up-to-date (UTD) rates, controlling for race/ethnicity and poverty level. By detailing OOP costs for each payer type and quantifying the degree to which a reduction in OOP costs will increase immunization coverage for a defined general population, this study advances the topical literature.

The Current Population Survey Annual Social and Economic Supplement (CPS) 2004 data provides information on insurance status by age, race/ethnicity, income, and location. We used the CPS to calculate the number of children in Georgia's 2003 birth cohort in each race and ethnicity group according to each payer category. 9   Because the 2004 CPS reported insurance status for children younger than 5 years, we assumed that (1) the entire birth cohort survived to 5 years of age and (2) insurance distribution did not vary by age.

This study incorporated data from multiple sources in an aggregate analysis that describes insurance and immunization coverage in Georgia (see Table 1 for details). We obtained benefit-plan data for 1217 health insurance plans registered in Georgia in 2003. These plans represented all potential payers in Georgia: (1) private insurers (employer-sponsored large-group plans, individually purchased and employer-sponsored small-group plans, and the military [Tricare]); (2) the uninsured; and (3) public payers (Medicare, Peachcare [Georgia's State Children's Health Insurance Program [SCHIP], and Medicaid). Table 2 describes the distribution of plans and the percentage of the 2003 Georgia birth cohort insured by each plan. 9  

For purposes of cost calculations, we assumed that the costs of services were fairly represented by the rate at which those services were reimbursed rather than some proportion of provider charges. We further assumed that (1) each child received all appropriate vaccines at the earliest eligible date according to the 2003 recommended immunization schedule, 10   (2) each visit after the birth visit included a well-child examination, all age-appropriate vaccines * , and a vaccine-administration fee for each injection, (3) all vaccines other than diphtheria, tetanus, and acellular pertussis and measles, mumps, and rubella were single-antigen vaccines, (4) no covered charges were disallowed by the insurer, (5) no vaccine shortages occurred, and (6) prices remained constant relative to each other during the study period. These assumptions reflect what parents could have reasonably expected when they anticipated the cost to vaccinate their child.

For each visit, the total cost per visit was calculated as the sum of the well-child examination fee, the vaccine antigen fee(s), and the vaccine-administration fee(s):

OOP costs per visit were calculated by applying any coinsurance or copayments to the fees charged for the well-child visit, the vaccine(s), and the vaccine-administration fee(s). For example, suppose a privately insured 6-month-old child received a well-child examination (fee = $75) and 5 vaccines totaling $175 in cost, with vaccine-administration fees of $10 for the first vaccine and $15 for each additional vaccine. The child would incur a total cost for the visit of $75 + $175 + $10 + $60, or $320. If insurance covered all costs other than a $20 copayment for the visit and 10% coinsurance for the vaccines and their administration, the total OOP costs would equal $20 + (10% of $245), for a total of $45.50 for that visit.

Reimbursement rates, copayments, and coinsurance rates for vaccines, vaccine-administration fees, and well-child examinations were obtained from separate sources, which depended on the type of insurer. For large-group, employer-sponsored private insurance plans, we obtained average reimbursement rates, copayments, and coinsurance rates for vaccine antigens, vaccine-administration fees, and well-child fees from Medstat's Marketscan 2003 insurance claims database according to plan type in Georgia. 11   For individual and small-group private insurance plans, we obtained average reimbursement rates according to plan type in Georgia for vaccine-administration fees and well-child fees from Medstat's Marketscan 2003 insurance claims database. Private-market wholesale vaccine prices were obtained from the Centers for Disease Control and Prevention (CDC) vaccine price list for 2003 and were increased by 25% to adjust for retail pricing. 12 , 13   Using benefit-plan data filed with Georgia's Department of Insurance in 2003, we obtained copayments and coinsurance rates for individual and small-group private insurance plans. We calculated average OOP and total costs per visit for each plan type, and results were weighted to reflect plan type distribution by using data from the CDC's Health Insurance Plan Enrollment Survey (Tricare South, unpublished data, 2005).

For children served by military health insurance (Tricare), the average total cost per visit was calculated by using military reimbursement rules on allowable reimbursements for vaccine antigens, vaccine administration, and well-child examinations in Atlanta and the rest of Georgia. Average OOP costs per visit were based on Tricare Extra copayments and coinsurance rates (Georgia Department of Community Health, unpublished data, 2004). Results were weighted by using the proportion of Georgia medical treatment facilities located in the Atlanta area versus the rest of Georgia to reflect military enrollments in the state.

In Georgia, children who are covered by Medicaid, Peachcare, and Medicare and those who are uninsured qualify for free vaccines through the VFC program. 14   For children who are covered by Medicaid and Peachcare, Georgia Medicaid regulations governed reimbursement rates, vaccine-administration fees, and well-child visit rates for both Medicaid and Peachcare providers. Medicaid charged no monthly premium. Infants from households with incomes up to 200% of the federal poverty level (FPL) and children aged 1 to 5 years from households up to 133% of the FPL were eligible for Medicaid. The Peachcare monthly premium was graduated on the basis of the ability to pay and did not exceed $20 for ≥2 children in the same household in 2003. Children from households up to 235% of the FPL were eligible for the program. 14   We used data on Medicaid-allowable charges and VFC vaccine prices to calculate the total costs per visit for Medicaid- and Peachcare-covered children. 12 , 14   Medicare did not cover well-child examinations or childhood vaccines in 2003. 15   Therefore, Medicare-covered children were eligible for free vaccines through the VFC but had no insurance coverage for vaccine-administration fees and well-child visits. As a result, Medicare-covered children faced the same OOP costs for immunizations as did children with no health insurance coverage. Although the VFC does not cover vaccine-administration charges, the maximum vaccine-administration fee that VFC providers are allowed to charge is set by the Centers for Medicare and Medicaid Services. We used VFC vaccine prices, Georgia VFC-allowed vaccine-administration charges, and Medicaid-allowable charges for well-child examinations to calculate cost per visit for Medicare-covered and uninsured children. 12 , 14  

To calculate the cost in 2003 dollars of a child's vaccinations and associated well-child visits, we summed the cost of the 7 visits and then discounted on a monthly basis by using a 3% annual discount rate:

Here, visit 1 represents the cost of the first visit, r is the annual discount rate of 3%, and m is 12, which represents the monthly basis for compounding. We performed a similar calculation to obtain the present value of OOP costs of a child's vaccinations and associated well-child visits for children aged 0 to 4 years. 16  

We multiplied the total and OOP costs per child in each payer category by the number of children in each payer category. Our results represent the population-weighted total and OOP costs to immunize Georgia's 2003 birth cohort.

To assess possible associations between costs and UTD coverage, we calculated the correlation between (1) 4:3:1:3:3 UTD immunization coverage and the OOP costs for the 4:3:1:3:3 series and (2) 4:3:1:3:3 UTD immunization coverage and the proportion of population below 250% of the FPL by using the National Immunization Survey 2003 data. † for Georgia. 17   Statistical analysis was conducted by using Pearson correlation coefficients and simulation by using a weighted generalized linear model with log link, which was weighted for the proportion of population in each insurance category and given race/ethnicity in that insurance category. Keeping in mind that the 7 payer types represented the state of Georgia, we bootstrapped our results by (1) randomly sampling 1000 times from the data with replacement, assuming a log-normal distribution and (2) generating data from a fitted distribution for simulation.

In the Georgia 2003 birth cohort, most children (66%) were covered by private insurance (57% large-group insurance, 7% small-group/individual insurance, and 2% military). Almost 14% were not covered by any type of insurance. The remaining 20% of children were publicly insured (〈1% Medicare, 8% Peachcare, and 12% Medicaid). Among privately insured children, ∼61% were white, 34% nonwhite, and the remaining 5% Hispanic. Nonwhite children were primarily black but also included children of American Indian, Alaskan Native, Native Hawaiian, Pacific Islander, Asian, and mixed-race descent. Uninsured children were 34% white, 45% nonwhite, and 21% Hispanic. Children covered by public insurance were 51% white, 40% nonwhite, and 8% Hispanic. Table 2 shows the Georgia 2003 birth cohort according to insurance plan type and race/ethnicity.

During the first year of life, the typical immunization visit, which occurs after the birth visit, cost an average of $264 (range: $192–$347). OOP costs averaged $59 per visit (range: $0–$122). When considering all immunization visits of children through 4 years of age, after the birth visit, the average visit cost was $228 (range: $166–$297), and OOP costs averaged $53 per visit (range: $0–$111). Children covered by Medicaid/Peachcare had the lowest average cost per immunization visit and lowest average OOP cost. Children covered by individual/small-group insurance had the highest average cost per visit. Uninsured children and those covered by Medicare had the highest average OOP cost per visit. Table 3 presents total and OOP costs for each immunization visit according to insurance status and type and total costs to vaccinate a child.

In general, vaccines accounted for the largest portion of total cost, followed by well-child visits and administration fees (Fig 1 ). In contrast, vaccines represented the smallest component of OOP costs, followed by administration fees and well-child visits. Total costs were highest for the large-group privately insured and declined toward public insurance. OOP costs were lowest for Medicaid/Peachcare, which was followed by the large-group privately insured. OOP costs were highest among the uninsured and children covered under Medicare.

Total costs were highest for non-Hispanic white children and lowest for nonwhite Hispanic children. OOP costs were highest for white Hispanic children and lowest for nonwhite Hispanic children (Fig 2 ).

The total cost to immunize Georgia's 2003 birth cohort from 0 to 4 years of age was $190.9 million (CI: $158.6 to $237.9). Approximately $22.6 million (95% CI: $20.2 to $25.1) was paid OOP at the point of service. Although 57% of Georgia's children were covered by large-group employer-sponsored insurance, they accounted for 67% of total costs and 37% of OOP costs. Small-group–and individually insured children comprised 7% of the cohort and faced 8% of total costs and 7% of OOP costs. Military-insured children comprised just over 2% of the cohort and faced 2% of total costs and nearly 4% of OOP costs. The uninsured, which comprised ∼14% of the cohort, faced 10% of total costs and 50% of OOP costs. Less than 1% (0.4%) of the children were covered by Medicare; they faced 0.3% of total costs and >1% of OOP costs. The remaining 20% of children were covered by Medicaid or Peachcare. Approximately 13% of total costs and 0% of OOP costs were attributed to this group.

More than 55% of Georgia's 2003 birth cohort was white; ∼57% of total costs and 48% of OOP costs were attributed to them. Nearly 37% of the cohort was nonwhite; almost 36% of total costs and 39% of OOP costs were attributed to them. Although just over 7% of the birth cohort was white Hispanic, <7% of total costs and 13% of OOP costs were attributed to these children. The remaining 0.6% of the cohort was nonwhite Hispanic; they paid ∼0.5% of total costs and 0.4% of OOP costs.

By using simple 1-way correlation, immunization coverage was negatively correlated with OOP costs to bring children UTD for 4:3:1:3:3 (ρ = −0.71) and negatively correlated with the proportion of enrollees below 250% of the FPL (ρ = −0.49) (Tables 4 and 5 ). When controlling for race/ethnicity and the proportion of the cohort in each insurance category, 1% increase in OOP cost of the 4:3:1:3:3 series was associated with a 0.07% (95% CI: −0.090 to −0.056; P < .01) reduction in 4:3:1:3:3 UTD coverage. Similarly, a 1% increase in the proportion of enrollees below 250% of the FPL was associated with a 0.09% (95% CI: −0.105 to −0.071; P < .05) reduction in 4:3:1:3:3 UTD coverage.

This study, an aggregate analysis that incorporated data from multiple sources that describe insurance and immunization coverage in Georgia, indicated that ∼12% of all vaccination costs were paid OOP. The burden of these OOP costs fell disproportionately on the uninsured; although the uninsured comprised 14% of the population, they paid >50% of all OOP costs. These children also experienced the lowest UTD immunization rates of children in our sample (63.7%). Note that 70% of Georgia's uninsured children lived in households with an income below 250% of the FPL; at least 1 adult was employed in 78% of the uninsured households. 9   In contrast to the uninsured, children covered by Medicaid and Peachcare experienced the lowest OOP costs, and immunization coverage among this group was 79.1%, which was nearly equivalent to coverage among children who were privately insured. This finding, that low OOP costs are associated with increased coverage, indicates the value of decreasing OOP costs for low-income families in promoting immunization coverage.

A number of studies have suggested that decreasing OOP costs will increase immunization coverage. 18 – 23   The Task Force on Community Preventive Services noted in their “Guide to Community Preventive Services” that strong evidence indicates the effectiveness of increasing UTD coverage by reducing OOP costs. 24   In their review, a 15% median increase in vaccination coverage was achieved by a reduction in OOP expenses, by providing free vaccines, reducing administrative costs, providing insurance when it was lacking, reducing copayments at the point of service. Our study quantified the degree to which a reduction in OOP cost could be effective, and we found that a 1% decrease in OOP cost would result in a 0.07% increase in UTD coverage. Assuming constant elasticity, the elimination of all OOP expenses in Georgia (ie, a reduction of the mean OOP costs of $175 per person to $0) would result in a 7% UTD increase in immunization coverage for the 4:3:1:3:3 series, which would bring coverage to 85.4% statewide at a cost of $19.1 million.

One strategy to decrease OOP expenses for childhood immunizations is to increase enrollments in Medicaid/SCHIP of the uninsured and underinsured who are already eligible and/or to relax eligibility requirements. However, increased enrollment would have budget implications beyond immunization-related costs and the funding of both Medicaid and SCHIP have not kept pace with enrollment expansion. 25 – 30   In fact, in 2005, 20 states tightened Medicaid/SCHIP eligibility criteria, which made enrollment in the programs more difficult, and 21 states reduced program benefits and/or increased cost sharing. 28   These measures may contribute to reduced immunization coverage among who are those not eligible for enrollment. A sustained, comprehensive, state-based approach to these regulations is needed to reverse this trend.

In our study, the majority of OOP immunization costs were incurred during the first year of life, when parents often experience a reduced income that is related to time off work for the mother and additional expenses for the new child. Parents who anticipate preventive care consider OOP vaccination costs against expenses for other necessities. Annually, the average family of 4 spends $2581 for health care and $7472 for food. 31   During the first year of a child's life, average OOP vaccination costs are $242. Although these OOP vaccination costs may not seem steep by comparison, for the uninsured, average OOP vaccination costs during the first year are $652. These OOP costs may compete unsuccessfully with other monthly necessities, especially because, in 2003, 11% of families in Georgia lived below the FPL ($18400 annually for a family of 4). 31  

Although children covered by Medicare represented only a very small proportion of children in Georgia (0.4%), OOP costs experienced among these children on an individual level were equivalent to those incurred by uninsured children. Children covered by Medicare are dependents of Medicare beneficiaries, such as children in the care of grandparents, who may experience unique difficulty in covering immunization-related costs because of their fixed income and their own increasing age-related personal medical costs. These children should be considered to be at risk for underimmunization. Medicare coverage of well-child visits and administrative fees associated with dependent minor children's immunization visits would help ensure that such children receive recommended immunizations. To help ensure that such children receive recommended immunizations, the well-child visit and administrative fees associated with dependent minor children's immunization visits should be covered by Medicare.

OOP costs per child did not differ significantly according to racial/ethnic group when controlling for payer category and poverty, except for white Hispanic children. White Hispanic children, who make up 21% of the Georgia's uninsured children but represent only 14% of the total population, incurred the highest OOP costs.

This study has several limitations. The analysis was conducted at the aggregated insurance-plan type level and may, therefore, be subject to ecologic fallacy. However, the negative association between OOP price and demand for a product has been well documented at the individual and aggregate levels, which suggests that ecologic fallacy is unlikely. The analysis was limited to Georgia, which is not representative of the United States. Georgia, however, does include a demographically diverse population, and Peachcare, Georgia's SCHIP, is separate from Medicaid, as is the case in 18 other states. The Health Insurance Plan Enrollment Survey (CDC institutional review board protocol 4205), which provided plan enrollments used to weight private insurance, had a 61% response rate. With the exception of large-group insurance, copayments were based on benefit-plan descriptions. Weights for military insurance were based on the locations of medical treatment facilities rather than the locations of military personnel in Georgia. Although we do not believe these limitations greatly impacted our results, the degree of sensitivity of the results to these assumptions is reflected in the CIs surrounding our estimates.

For most Georgia families, OOP expenses for childhood immunizations were fairly low, which favored compliance with the recommended immunization schedule. However, families who were less able to afford the expense, the uninsured, faced disproportionately high OOP costs. OOP costs were significantly inversely correlated with immunization coverage levels so that uninsured children whose families lived below 250% of the FPL experienced the lowest immunization coverage levels. Enrollment in and immunization insurance coverage through the VFC program and Medicaid/SCHIP should be promoted to minimize or eliminate OOP costs related to childhood immunizations, especially among children of low-income families.

FIGURE 1. Total and OOP costs (2003 US dollars) per child according to insurance type for children aged 0 to 5 years.

Total and OOP costs (2003 US dollars) per child according to insurance type for children aged 0 to 5 years.

FIGURE 2. Total and OOP costs (2003 US dollars) per child according to race/ethnicity for children aged 0 to 5 years. Nonwhite includes black, Asian, American Indian/Alaskan Native, Native Hawaiian/Pacific Islander, and ≥2 races.

Total and OOP costs (2003 US dollars) per child according to race/ethnicity for children aged 0 to 5 years. Nonwhite includes black, Asian, American Indian/Alaskan Native, Native Hawaiian/Pacific Islander, and ≥2 races.

Data Sources for Childhood Immunization Costs

NA indicates not applicable.

Georgia 2003 Birth Cohort According to Insurance and Race/Ethnicity

Weighted estimate is <10 children.

Costs of Immunization and Well-Child Visits Through 4 Years of Age

All amounts are shown in 2003 US dollars. PV indicates present value

OOP Payment Rate and UTD Percentage of 4:3:1:3:3

UTD Percentage indicates the percent of 19- to 35-month-old children who are UTD for the recommended immunizations in the 4:3:1:3:3 series.

Correlates for UTD Percentage of 4:3:1:3:3

Note that correlation coefficient and elasticity are unit-free measures.

Significant at <1%.

Significant at <5%.

Controls for race/ethnicity and percent population in each insurance category.

The authors have indicated they have no financial relationships relevant to this article to disclose.

We concluded that well-child visits with each immunization after birth because this represents the gold standard of care. Although uninsured children can receive immunizations at a federally qualified health center or rural health center without the concurretn well-child visit, this represents a suboptimal outcome. Furthermore, pediatricians do not routinely provide immunizations without the concurrent well-child visit.

We used 4:3:1:3:3 UTD, which indicates the proportion of 19- to 35-month-olds who are UTD for recommended vaccinations and received the 4:3:1:3:3 series.

We thank Dr Philip J. Smith, who provided Georgia's immunization coverage rates, and Edith Gary and Heather Purk for research assistance.

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Well-child visits.

It's important for your child to have regularly scheduled checkups, often called well-child visits, beginning shortly after birth and lasting through the teen years.

These appointments allow your doctor to keep a close eye on your child's general health and development. Finding possible problems early gives your child the best chance for proper and successful treatment. Also, any concerns you have about your child can be discussed during these visits.

During these visits, the doctor examines your child and asks you questions about your child's development and behavior. Immunizations also are either given or scheduled at this time.

Your child's doctor will recommend a schedule for well-child visits. One example is for visits at ages: footnote 1

  • 3 to 5 days old.
  • By 1 month.

After age 3, well-child visits are usually scheduled yearly through the teen years.

Citations Bright Futures/American Academy of Pediatrics (2020). Recommendations for preventive pediatric health care. American Academy of Pediatrics . https://downloads.aap.org/AAP/PDF/periodicity_schedule.pdf. Accessed February 27, 2020.

Current as of: October 24, 2023

Author: Healthwise Staff

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Well-Child Care

Improving infant well-child visits.

High-quality well-child visits can improve children’s health, support caregivers’ behaviors to promote their children’s health, and prevent injury and harm. The American Academy of Pediatrics and Bright Futures recommend nine well-care visits by the time children turn 15 months of age. These visits should include a family-centered health history, physical examination, immunizations, vision and hearing screening, developmental and behavioral assessment, an oral health risk assessment, a social assessment, maternal depression screening, parenting education on a wide range of topics, and care coordination as needed. i  When children receive the recommended number of high-quality visits, they are more likely to be up-to-date on immunizations, have developmental concerns recognized early, and are less likely to visit the emergency department. ii , iii , iv , v , vi , vii  However, many infants do not receive the recommended number of infant well-child visits. 

The Centers for Medicare & Medicaid Services (CMS) offers quality improvement (QI) technical assistance (TA) to help states increase the attendance and quality of well-child visits for Medicaid and Children’s Health Insurance Program (CHIP) beneficiaries ages 0 to 15 months.

QI TA resources , to help state Medicaid and CHIP staff and their QI partners get started improving the use of infant well-child visits for their beneficiaries

Improving Infant Well-Child Visit learning collaborative resources , to share different approaches to improving well-child visit care and state examples

For more information on these materials and other QI TA, please email [email protected] .

QI TA Resources

These resources can help states get started in developing their own infant well-child QI projects:

Getting Started on Quality Improvement Video (Coming Soon). This video provides an overview of how Medicaid and CHIP agencies can start a QI project to improve the use of infant well-child visits. The Model for Improvement begins with small tests of change, enabling state teams to “learn their way” toward strong programs and policies.

Driver Diagram and Change Idea Table . A driver diagram is a visual display of what “drives” or contributes to improvements in infant well-child visits. This example of a driver diagram shows the relationship between the primary drivers (the high-level elements, processes, structures, or norms in the system that must change to use and quality of infant well-child visits) and the secondary drivers (the places, steps in a process, time-bound moments, or norms in which changes are made to spur improvement). The document also includes change idea tables, which contain examples of evidence-based or evidence-informed QI interventions to improve the use of infant well-child care. The change ideas were tailored for Medicaid and CHIP.

Measurement Strategy . This document provides examples of measures that can be used to monitor infant well-child care QI projects.

Improving Infant Well-Child Visits: Learning Collaborative Resources

Beginning in 2021, CMS facilitated the two year Infant Well-Child Visit learning collaborative to support state Medicaid and CHIP agencies’ efforts to improve the use of infant well-child visits from 0-15 months of age. The learning collaborative included a webinar series and an affinity group to support state Medicaid and agencies’ quality improvement efforts. The webinars, listed and linked to below, described approaches that states can use to improve attendance and quality of infant well-child visits.

California, Missouri, North Carolina, South Carolina, Texas and Virginia participated in the action-oriented affinity group where teams designed and implemented an infant well-child quality improvement (QI) project in their state with tailored TA from CMS. Learnings from participating states can be found in the state highlights brief.

Learning Collaborative Webinar Series

State Spotlights Webinar on Improving Infant-Well Child Care ( Video ) ( Transcript ). This 2024 webinar spotlighted several state QI projects from the affinity group, highlighting their strategies, partnerships, and lessons learned.

Using Payment, Policy and Partnerships to Improve Infant Well-Child Care ( Audio )( Transcript ). This August 2021 webinar focused on Medicaid and CHIP payment incentives, managed care contracts, and other strategies that can increase the use and quality of infant well-child visits and advance equity. Speakers from the CMS and Mathematica introduced CMS’ Maternal and Infant Health Initiative and shared the importance of high-quality well-child visits and the opportunities within Medicaid and CHIP to impact infant health. Speakers from Pennsylvania and Texas’ Medicaid and CHIP agencies described their efforts to expand and incentivize participation in infant well-child visits, such as through value-based purchasing, performance improvement projects, CHIP Health Services Initiatives (HSIs), and partnerships with aligned service providers like the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). State presenters offered insights into ways to incentivize efforts to close gaps in care, engage families, and improve performance on quality measures. During the Q&A session, presenters discussed the impact of the COVID-19 pandemic on well-child care, the potential of using telehealth or hybrid visits to increase access, and incentives for managed care entities, and addressing the social determinants of health in value-based payment strategies.

  Improving Quality and Utilization of Infant Well-Child Visits ( Audio )( Transcript ). This September 2021 webinar focused on the characteristics of a high-performing system of well-child health care. CMS and Mathematica presenters shared the Maternal and Infant Health Initiative’s Theory of Change. Speakers from Washington and Arkansas Medicaid and CHIP agencies discussed how their states have achieved high rates of participation in infant well-child visits and how they use data to monitor performance and disparities and ensure access to services. Washington shared insights on leveraging collaborative performance improvement projects to identify and address barriers to care. Arkansas discussed the state’s per member per month incentives for performance and minimum performance measures for infant well-child visit rates. During the Q&A session, presenters highlighted efforts to improve health equity, engage parents and providers, and leverage performance measures and quality tools to improve attendance at infant well-child visits.

Models of Care that Drive Improvement in Infant Well-Child Visits ( Audio )( Transcript ). In this September 2021 webinar, three states—Oregon, Michigan, and North Carolina—shared approaches to designing and implementing models of care associated with improved infant well-child visit participation, including patient-centered medical homes (PCMHs) and home visiting. States offered insights on the importance of strategic alignment of policies, processes, and partnerships. Oregon discussed its home visiting program and quality incentive strategy for its coordinated care organizations. The state incentivizes progress on the HEDIS measures and other measures designed by the state’s Pediatric Improvement Partnership, including a measure of social-emotional health service capacity and access for infants and children. Michigan discussed how they requires MCOs to identify and publish disparities in well-child visit rates and how they encourage plans to reduce disparities. The state also uses an algorithm that automatically assigns members to MCOs based on MCOs’ performance and reimburses for maternal-infant health home visiting. North Carolina shared its Keeping Kids Well program, which aims to increase well-child visit and immunization rates and reduce disparities in those rates. The program offers coaches to practices to support their improvements, established an advisory board of key interested parties, and provides customized vaccination notices for practices to distribute to beneficiaries, in partnership with health systems and pharmaceutical companies. The state also used the Healthy Opportunities payment to incentivize the identification and redress of health-related social needs and provided the Health Equity Payment to providers serving areas with high poverty rates. 

i 3 Hagan, J.F., J.S. Shaw, and P.M. Duncan (eds.). Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents. 4th ed. Elk Grove Village, IL: American Academy of Pediatrics, 2017.

ii Gill, J.M., A. Saldarriaga, A.G. Mainous, and D. Unger. “Does Continuity Between Prenatal and Well-Child Care Improve Childhood Immunizations?” Family Medicine, vol. 34, no. 4, April 2002, pp. 274–280.

iii Buchholz, M., and A. Talmi. “What We Talked About at the Pediatrician’s Office: Exploring Differences Between Healthy Steps and Traditional Pediatric Primary Care Visits.” Infant Mental Health Journal, vol. 33, no. 4, 2012, pp. 430–436.

iv DeVoe, J.E., M. Hoopes, C.A. Nelson, et al. “Electronic Health Record Tools to Assist with Children’s Insurance Coverage: A Mixed Methods Study.” BMC Health Services Research, vol.18, no. 1, May 2018, p. 354–360.

v Coker, T.R., S. Chacon, M.N. Elliott, et al. “A Parent Coach Model for Well-Child Care Among Low-Income Children: A Randomized Controlled Trial.” Pediatrics, vol. 137, no. 3, March 2016, p. e20153013.

vi Flores, G., H. Lin, C. Walker, M. Lee, J. Currie, R. Allgeyer, M. Fierro, M. Henry, A. Portillo, and K. Massey. “Parent Mentoring Program Increases Coverage Rates for Uninsured Latino Children.” Health Affairs, vol. 37, no. 3, 2018, pp. 403–412.

vii Hakim, R.B., and D.S. Ronsaville. “Effect of Compliance with Health Supervision Guidelines Among US Infants on Emergency Department Visits.” Archives of Pediatrics & Adolescent Medicine, vol. 156, no. 10, October 2002, pp. 1015–1020.

Catch Up on Well-Child Visits and Recommended Vaccinations

A happy child in a lion custome. Text: Let's play catch-up on routine vaccines

Many children missed check-ups and recommended childhood vaccinations over the past few years. CDC and the American Academy of Pediatrics (AAP) recommend children catch up on routine childhood vaccinations and get back on track for school, childcare, and beyond.

laughing girl at the beach.

Making sure that your child sees their doctor for well-child visits and recommended vaccines is one of the best things you can do to protect your child and community from serious diseases that are easily spread.

Well-Child Visits and Recommended Vaccinations Are Essential

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Well-child visits and recommended vaccinations are essential and help make sure children stay healthy. Children who are not protected by vaccines are more likely to get diseases like measles and whooping cough . These diseases are extremely contagious and can be very serious, especially for babies and young children. In recent years, there have been outbreaks of these diseases, especially in communities with low vaccination rates.

Well-child visits are essential for many reasons , including:

  • Tracking growth and developmental milestones
  • Discussing any concerns about your child’s health
  • Getting scheduled vaccinations to prevent illnesses like measles and whooping cough (pertussis) and  other serious diseases

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It’s particularly important for parents to work with their child’s doctor or nurse to make sure they get caught up on missed well-child visits and recommended vaccines.

Routinely Recommended Vaccines for Children and Adolescents

Getting children and adolescents caught up with recommended vaccinations is the best way to protect them from a variety of   vaccine-preventable diseases . The schedules below outline the vaccines recommended for each age group.

Easy-to-read child schedule.

See which vaccines your child needs from birth through age 6 in this easy-to-read immunization schedule.

Easy-to-read teen schedule.

See which vaccines your child needs from ages 7 through 18 in this easy-to-read immunization schedule.

The  Vaccines for Children  (VFC) program provides vaccines to eligible children at no cost. This program provides free vaccines to children who are Medicaid-eligible, uninsured, underinsured, or American Indian/Alaska Native. Check out the  program’s requirements  and talk to your child’s doctor or nurse to see if they are a VFC provider. You can also find a VFC provider by calling your  state or local health department  or seeing if your state has a VFC website.

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COVID-19 Vaccines for Children and Teens

Everyone aged 6 months and older can get an updated COVID-19 vaccine to help protect against severe illness, hospitalization and death. Learn more about making sure your child stays up to date with their COVID-19 vaccines .

  • Vaccines & Immunizations

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Medicaid & CHIP

The children's health insurance program (chip), see if your children qualify and apply for chip, 2 ways to apply for chip:.

  • Call 1-800-318-2596 (TTY: 1-855-889-4325).
  • Fill out an application through the Health Insurance Marketplace ® . If it looks like anyone in your household qualifies for Medicaid or CHIP, we’ll send your information to your state agency. They’ll contact you about enrollment. When you submit your Marketplace application, you’ll also find out if you qualify for an individual insurance plan with savings based on your income instead.  Create an account  or  log in  to an existing account to get started.

What CHIP covers

  • Routine check-ups
  • Immunizations
  • Doctor visits
  • Prescriptions
  • Dental and vision care
  • Inpatient and outpatient hospital care
  • Laboratory and X-ray services
  • Emergency services

What CHIP costs

A fixed amount ($20, for example) you pay for a covered health care service after you've paid your deductible.

Refer to glossary for more details.

The amount you pay for your health insurance every month. In addition to your premium, you usually have to pay other costs for your health care, including a deductible, copayments, and coinsurance. If you have a Marketplace health plan, you may be able to lower your costs with a premium tax credit.

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IMAGES

  1. Well Child Visit Schedule

    average cost of well child visit with insurance

  2. The Pediatric Center of Frederick

    average cost of well child visit with insurance

  3. Interventions Reduce Racial Gaps in Pediatric Well-Visit Rates

    average cost of well child visit with insurance

  4. Figure 1, Percentage of all children with a well-child visit, 2002-2009

    average cost of well child visit with insurance

  5. Schedule Your Child's CHDP Well Visit

    average cost of well child visit with insurance

  6. Importance of Well Child Visits During COVID-19

    average cost of well child visit with insurance

COMMENTS

  1. Trends in Well-Child Visits With Out-of-Pocket Costs in the US Before

    Although the proportion of well-child visits with out-of-pocket costs declined from 73% before passage of the ACA to 49% in 2011 and 2012, 2 the evolution of trends in out-of-pocket costs is unknown. We used national claims data to describe cross-sectional trends in well-child visits with out-of-pocket costs from 2006 through 2018. Methods

  2. Pediatric Doctor Visit Cost With and Without Insurance in 2024

    The average cost of a pediatrician visit without insurance is around $100. Still, if you add in the price of immunizations and other out-of-pocket expenses, this can amount to over $3,000 in a single year. Average Cost of Pediatrician Visits Without Insurance

  3. The Impact of the Pandemic on Well-Child Visits for Children ...

    How did use of well-child visits change during the pandemic? More than half (54%) of children under 21 enrolled in Medicaid or CHIP received a well-child visit in 2019, but the share fell to 48% ...

  4. Cost of pediatrician visit by state

    The following estimated costs are based on cash prices that providers have historically charged on average for pediatrician visit and will vary depending on where the service is done. The prices do not include the anesthesia, imaging, and other doctor visit fees that normally accompany pediatrician visit. Need help to cover that price?

  5. A comprehensive guide to well-child visits

    Find a pediatrician Call (502) 629-5437 (KIDS), option 3 Every parent wants to know that their child is growing and healthy. A well-child visit is a crucial part of every child's health care journey, from the time they are born until they reach adulthood. A well-child visit is a regularly scheduled health check up with your child's pediatrician.

  6. How Much Does A Well Baby Doctor Visit Cost?

    Uninsured - $300 to $600 per exam on average Insured, without meeting deductible - $100 to $300 per visit Insured, after meeting deductible - $20 to $50 copay per visit Your total first year well exam expenses could range anywhere from $700 to $3,000+. Geography, your insurer, and specific pediatric office fees will determine your actual rates.

  7. Child Health Insurance Coverage: Screening, Vaccines, & More

    At 1 week old At 1 month old At 2 months old At 4 months old Every three months from 6 months old to 18 months old At 2 years old and 2 1/2 years old Every year from 3 years old until age 18 These...

  8. Well-Child Visit: What's Included and When to Go

    Are Well-Child Visits Covered by Insurance? 3 min read Well visits are key to child health and pediatric medicine. Here's what to know about a well-child visit. What Is a Well...

  9. Preventive care benefits for children

    Most health plans must cover a set of preventive health services for children at no cost. This includes Marketplace and Medicaid coverage. Notice: IMPORTANT These services are free only when delivered by a doctor or other provider in your plan's network. Coverage for children's preventive health services

  10. Well-Child Visits for Infants and Young Children

    Immunizations are usually administered at the two-, four-, six-, 12-, and 15- to 18-month well-child visits; the four- to six-year well-child visit; and annually during influenza season ...

  11. AAP Schedule of Well-Child Care Visits

    The Bright Futures /American Academy of Pediatrics (AAP) developed a set of comprehensive health guidelines for well-child care, known as the " periodicity schedule ." It is a schedule of screenings and assessments recommended at each well-child visit from infancy through adolescence. Schedule of well-child visits

  12. Preventive Services Covered by Private Health Plans under the ...

    The preventive services guidelines require coverage for adults and children and include immunizations such as influenza, meningitis, tetanus, HPV, hepatitis A and B, measles, mumps, rubella ...

  13. Make the Most of Your Baby's Visit to the Doctor (Ages 0 to 11 Months)

    Under the Affordable Care Act, insurance plans must cover well-child visits. Depending on your insurance plan, you may be able to get well-child visits at no cost to you. Check with your insurance company to find out more. Your child may also qualify for free or low-cost health insurance through Medicaid or the Children's Health Insurance ...

  14. Trends in Well-Child Visits With Out-of-Pocket Costs in the US Before

    Introduction. In the US, both Medicaid and the Children's Health Insurance Program exclude well-child care from cost sharing, but out-of-pocket costs present a barrier to accessing preventive services for privately insured children. 1 The promised elimination of these costs is a popular provision of the Affordable Care Act (ACA). Although the ...

  15. How Much Does A Pediatrician Visit Cost Without Insurance

    Published: November 23, 2023 Without insurance, the cost of a pediatrician visit can vary. Learn about the different factors that can impact the price and find ways to manage your finances effectively. (Many of the links in this article redirect to a specific reviewed product.

  16. Well child visit vs Office Visit

    A well-child visit, also known as a preventive visit or check-up, is an appointment made to assess a child's overall health and well-being.These visits may include screenings, immunizations, and other preventative measures. An office visit, on the other hand, refers to an appointment made with a healthcare provider for any reason, including diagnosis and treatment of illnesses or injuries ...

  17. Your Guide to Well-Baby Visits During Your Child's First Year

    Your baby's first official checkup (and first immunization) will take place at the hospital. After that, well-baby visits are scheduled throughout the first two years at: The first week (usually a couple of days after you're discharged from the hospital) 1 month. 2 months. 4 months. 6 months. 9 months.

  18. Out-of-Pocket Costs of Childhood Immunizations: A Comparison by Type of

    BACKGROUND. The "Guide to Community Preventive Services" strongly recommends reducing out-of-pocket costs to increase vaccination rates among children. Nevertheless, out-of-pocket expenses are still incurred during the receipt of childhood vaccines, vaccine administration, and associated well-child visits.OBJECTIVE. Our goal was to estimate total and out-of-pocket costs of childhood ...

  19. Well-Child Visits

    1 year. 15 months. 18 months. 2 years. 30 months. 3 years. After age 3, well-child visits are usually scheduled yearly through the teen years. References Current as of: October 24, 2023 Author: Healthwise Staff Clinical Review Board

  20. Well-Child Care

    The Centers for Medicare & Medicaid Services (CMS) offers quality improvement (QI) technical assistance (TA) to help states increase the attendance and quality of well-child visits for Medicaid and Children's Health Insurance Program (CHIP) beneficiaries ages 0 to 15 months.

  21. Well-Child Visits and Recommended Vaccinations

    The Vaccines for Children (VFC) program provides vaccines to eligible children at no cost. This program provides free vaccines to children who are Medicaid-eligible, uninsured, underinsured, or American Indian/Alaska Native. Check out the program's requirements and talk to your child's doctor or nurse to see if they are a VFC provider.

  22. Children's Health Insurance Program (CHIP) Eligibility Requirements

    2 ways to apply for CHIP: Call 1-800-318-2596 (TTY: 1-855-889-4325). Fill out an application through the Health Insurance Marketplace ®. If it looks like anyone in your household qualifies for Medicaid or CHIP, we'll send your information to your state agency. They'll contact you about enrollment. When you submit your Marketplace ...

  23. § 4-215. Child(ren)'s health insurance, nonreimbursed health care

    As required by Neb. Rev. Stat. § 42-369(2), the child support order shall address how the parents will provide for the child(ren)'s health care needs through health insurance as well as the nonreimbursed reasonable and necessary child(ren)'s health care costs that are not included in table 1 that are provided for in § 4-215(B). (A) Health Insurance.