Does Medicare Cover Annual Physicals?
- Medicare provides coverage for an annual “wellness visit” but doesn’t cover a traditional physical exam. Learn about the difference and find out what will be covered for you.
While Medicare does not cover a traditional annual physical, it does cover an “annual wellness visit.”
Are you confused yet? Don’t worry, so are a lot of Medicare beneficiaries.
The Medicare annual wellness visit is similar to a physical but does not include blood work or some of the other tests or services that are part of a typical physical exam.
While the yearly wellness visits may sound less complete than a yearly physical, they’re designed to take a more personal view of one’s health to catch potentially serious health issues early. Medicare believes this approach is highly important for preventing disease and ensuring a senior’s long-term health.
Some Medicare Advantage (Medicare Part C) plans may include additional coverage for a more traditional annual physical exam. Medicare Advantage plans are sold by private insurance companies, and many plans offer more benefits than what’s covered by Original Medicare (Medicare Part A and Part B).
What Is Included in the Annual Wellness Visit?
The annual wellness visit serves as a yearly follow-up to your initial Welcome to Medicare medical exam. It provides an opportunity for your doctor to update your personalized prevention plan and compare how your health has changed from the previous year.
Your annual wellness visit will include many of the same services conducted in your Welcome to Medicare visit, along with:
- A cognitive impairment assessment to detect signs of Alzheimer’s Disease or dementia
- Updates to your list of current health care providers and prescriptions
- Personalized health advice based on your current condition
- Updates to your list of current risk factors and treatment options
- A screening schedule for appropriate preventive services
- Advance care planning
You will also be asked to fill out a “Health Risk Assessment,” which is a questionnaire detailing your health, diet and lifestyle to note any changes from the previous year.
When you first become enrolled in Medicare Part B, your Welcome to Medicare preventive visit is covered within 12 months of your Part B coverage first taking effect.
This initial visit is designed to serve as a baseline measure of your health that can be compared with your subsequent annual wellness visits.
Your Welcome to Medicare visit includes:
- Reviews of your medical history
- Certain screenings
- Flu and pneumococcal shots
- Height, weight and blood pressure checks
- Body mass index (BMI) calculation
- Vision test
- Review of your risk for depression
- An offer to discuss advance directives
Your doctor will use this visit to form a personalized prevention plan, which is a written plan specifying which screenings, shots and other preventive services you need along with information about staying healthy and preventing diseases based on your current health, risk factors and lifestyle.
How Much Does Medicare Pay for the Annual Wellness Visit?
You will not pay anything for your Medicare annual wellness visit as long as the doctor performing the checkup accepts Medicare assignment. This means that your Part B annual deductible does not apply.
Just like the annual wellness visits, you will not pay anything for your Welcome to Medicare visit as long as your doctor accepts Medicare assignment. The Medicare Part B deductible does not apply.
How to Schedule Your Annual Wellness Visit
If you wish to schedule a Welcome to Medicare visit or annual wellness exam, be sure to use those terminologies when making your appointment. If you say “physical,” you might receive a more traditional physical exam, which means Medicare won’t cover the costs in full and you will be billed for it.
The Centers for Medicare & Medicaid Services (CMS) provides detailed information about the Welcome to Medicare visit, annual wellness visits and physical exams.