Does Medicare Cover Annual Physical Exams?

While Medicare does not cover traditional physical exams, it does cover a single Welcome to Medicare checkup followed by annual wellness visits.

 

Dear Savvy Senior,

Does Medicare cover annual physical exams? I’ve gotten a physical every year since I turned 50 and would like to find out what Medicare covers when I sign up in a few months.

–Almost 65

---

Dear Almost,

No, Medicare does not pay for annual physical exams, but it does cover a one-time “Welcome to Medicare” checkup during your first year after enrolling in Part B. And after that, it covers annual wellness visits to keep track of your health. Here’s what you should know.

 

Physical vs Wellness Exam

In an annual physical, a doctor examines you, may do bloodwork and other tests and looks for problems even though you don’t have a specific complaint or risk.

The Welcome to Medicare checkup and annual wellness visits are different. They focus primarily on preventive care.

Your doctor will review your risk factors, develop a personalized health plan for you, check that you’re up to date with preventive tests such as cancer screenings and flu shots and may refer you for other tests. Here’s a breakdown of what these exams may include.

 

Welcome to Medicare Checkup

This is an introduction to Medicare and focuses on health promotion, disease prevention and detection to help you stay well. It’s an opportunity for your doctor to assess your health and provide a plan for care. During this visit your doctor will:

• Take your height, weight, and blood pressure measurements, and calculate your body mass index (BMI).
• Ask about your personal and family health history.
• Give you referrals for other care as needed.
• Assess your potential for depression.
• Provide a simple vision test.
• Recommend vaccines, tests, screenings and other preventive services you need to stay healthy.
• Offer to talk with you about creating advance directives.

 

Annual Wellness Visit

This visit includes some of the same elements as the Welcome to Medicare checkup. For example, your doctor will review your medical history, record your vital information and give you an opportunity to talk about advance directives. Your doctor may also provide the following services:

• Create a screening checklist for recommended preventive services for the upcoming year.
• Look at health risks and treatment options.
• Perform a cognitive assessment to look for signs of dementia.
• Provide personalized health advice.
• Review your current prescriptions.
• Study risk factors for opioid problems if you have a prescription for opioids, and screen for potential substance use disorders.

 

Medicare Coverage 

The Welcome to Medicare and annual wellness visits are fully covered by Medicare Part B without any out-of-pocket costs. You don’t need the Welcome to Medicare visit to qualify for later annual wellness visits, but know that Medicare won’t pay for a wellness visit during the first 12 months you have Part B.

During these visits, the provider may order additional tests or procedures that may be subject to Medicare’s deductibles, copayments or coinsurance.

Make sure that when you book your appointment, you specifically ask for the Welcome to Medicare checkup or annual wellness visit to ensure Medicare covers it. Otherwise, you may have to pay for the visit.

If you’re enrolled in Medicare Advantage, you’ll probably need to use an in-network provider for the wellness visits to be covered. Some Medicare Advantage plans also cover annual physicals in addition to the wellness visit. Check your plan for details.