Does my dr automatically test for hiv at my annual exam? is that up to me to ask each time? does my insurance have any say?

No, Yes, Maybe!: No your doctor doesn't automatically test. You should ask if you have good reason to be tested. Insurance companies may pay or deny testing but can say whether to or not to. You doctor should question you at a yearly physical exam about your social history and sexual preferences and practices and if indicated suggest testing. If they don't ask, volunteer your concerns. Coverage is by plan.

It is not automatic: There is no standard for what to order during a check up, and doctors tend to order what they know about and think is important. Hiv testing is generally recommended if high-risk, but not routinely otherwise. Definitely ask if you want this testing or are unsure. A good resource to see what health screenings are right for you is an iphone app called my health checklist.