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Original Medicare doesn’t cover annual physicals, but it does cover a one-time Welcome to Medicare visit, as well as annual wellness visits. Some Medicare Advantage plans cover annual physicals.
What preventive visits are covered by Original Medicare?
Annual physicals aren’t covered under Medicare, however, Medicare Part B does cover two types of preventive visits:
During your first year on Medicare, you’re covered for a Welcome to Medicare preventive visit.
Once you’ve been on Medicare for a full 12 months, you’ll be covered for yearly wellness visits (which aren’t the same as full physical exams).
Medicare Part B also covers a number of recommended preventive screenings, services and vaccines that your doctor can order to monitor and maintain your health.
What is a Welcome to Medicare preventive visit?
A Welcome to Medicare preventive visit involves reviewing your medical (and health-related social) history along with performing some basic measurements, screenings and services, which include:
Blood pressure measurement.
Height, weight and body mass index.
Basic vision test.
Pneumococcal and flu vaccines.
Some health screenings and referrals for necessary care.
Depression risk assessment.
Advance directives discussion, if desired.
A written plan detailing which screenings, vaccinations and other preventive services are appropriate for you.
Be sure to let your doctor’s office know that the appointment is specifically for a Welcome to Medicare visit, so the staff will submit your claim properly and you’ll be covered.
To prepare for your Welcome to Medicare visit, bring a list of any prescription medications, over-the-counter drugs, supplements and vitamins you use along with your medical and immunization records — as well as your family’s health history if you have access to that information.
How much does the Welcome to Medicare visit cost?
The introductory Welcome to Medicare visit is free with no copay required as long as your provider accepts Medicare assignment — and this visit isn’t subject to the Part B deductible.
Be aware though that if your doctor performs additional Medicare-approved tests or services that aren’t included in the Welcome to Medicare visit, you may be responsible for the Part B deductible and/or coinsurance. If your doctor recommends or performs services more frequently than Medicare allows, or that aren’t covered at all by Medicare during this visit, you may be responsible for some or all of these costs.
What is a Medicare annual wellness visit?
A yearly wellness visit is designed to create or update a tailored health plan that can help you prevent or manage illness and disability. This visit shouldn’t be confused with a physical exam, which involves a hands-on head, neck, lung, neurological and abdominal examination, as well as taking blood and urine samples, checking vital signs and reflexes, and assessing disease risk factors.
A Medicare annual wellness visit includes:
Health risk assessment questionnaire.
Routine measurements including height, weight and blood pressure.
Review of your current prescriptions and medical providers.
Review of your medical and family history.
Cognitive assessment to screen for Alzheimer’s disease and other forms of dementia.
Screening schedule for recommended preventive screenings, vaccines and services.
A list of your risk factors and treatment options.
Specific personal health advice.
In addition, if you currently use prescription opioids, you’ll be evaluated for risk of opioid use disorder and have your pain and treatment plan reevaluated. You’ll be provided with non-opioid treatment alternatives and if needed, referred for substance use disorder treatment.
How much does a Medicare annual wellness visit cost?
Your wellness visit should be free as long as your health care provider accepts Medicare assignment. There are no copays for annual wellness visits, and the Part B deductible isn’t applicable.
Just like the Welcome to Medicare visit, however, if your doctor performs additional services and tests during your appointment that Medicare doesn’t cover fully or at all, you’ll be responsible for these costs. Make it clear to your provider’s office that you’re scheduling a Medicare wellness visit and not an annual physical to avoid receiving an unexpected bill.
Are annual physicals covered by Medicare Advantage?
Medicare Advantage plans are required to provide the same level of coverage as Original Medicare, so you’ll be covered for an introductory welcome visit and annual wellness visits. Because Medicare Advantage plans are offered through private health insurance companies, any additional coverage as well as specific copays, deductibles and coinsurance will vary.
A number of Medicare Advantage plans do cover yearly physical exams, some with a $0 copay. Always read plan and provider network details carefully, and compare benefits to make sure you select the Medicare Advantage plan that’s best for you.
If you have additional questions about Medicare, visit Medicare.gov or call 800-MEDICARE (800-633-4227, TTY 877-486-2048).