Does Medicare Pay for a Yearly Physical?

Medicare, the federal health insurance program, provides healthcare coverage for millions of Americans. Many individuals enrolling in Medicare, or those already covered, often inquire about the program’s coverage for a “yearly physical.” Medicare’s approach to preventive care differs from the traditional annual physical examination offered by many private insurance plans. Understanding these distinctions helps beneficiaries effectively utilize their healthcare benefits.

Medicare’s Approach to Annual Health Visits

Medicare Part B generally does not cover a traditional, comprehensive “full head-to-toe physical exam” that many people associate with an annual check-up. This type of exam, often including hands-on physical assessment and extensive diagnostic tests for general screening without specific symptoms, is not a covered benefit under Original Medicare. Instead, Medicare Part B focuses on specific preventive visits designed to assess health risks and develop personalized care plans.

Medicare covers two distinct types of preventive visits. The first is the “Welcome to Medicare” Preventive Visit, also known as the Initial Preventive Physical Examination (IPPE). This one-time benefit is available to individuals within the first 12 months of their Medicare Part B enrollment. The IPPE aims to establish a baseline health assessment and provide education on preventive services.

Following the “Welcome to Medicare” visit, or after the first 12 months of Medicare Part B enrollment, beneficiaries become eligible for an Annual Wellness Visit (AWV). This yearly benefit helps individuals develop or update a personalized prevention plan based on their current health and risk factors. Individuals do not need to have completed the “Welcome to Medicare” visit to qualify for an Annual Wellness Visit. These wellness visits prioritize preventive planning and risk assessment.

Components of Medicare-Covered Wellness Visits

The “Welcome to Medicare” Preventive Visit includes several elements for establishing a foundational health profile. A healthcare provider will review an individual’s medical and social history, including an assessment of potential risk factors for depression and substance use disorders.

Routine measurements are also taken, such as height, weight, blood pressure, and body mass index (BMI), along with a simple vision test. The visit provides an opportunity for counseling on personalized prevention and includes advice on various preventive screenings, like immunizations. Discussions about advance care planning may also be offered.

The Annual Wellness Visit focuses on updating an individual’s preventive health strategy. A health risk assessment (HRA) is completed, which helps identify health risks and provides a basis for the personalized prevention plan. Routine measurements, such as height, weight, and blood pressure, are also taken.

A review and update of the individual’s medical and family history, along with a review of current medications, are standard components. Healthcare providers also conduct assessments for cognitive impairment and evaluate functional ability. The visit culminates in health education and counseling, along with the creation or update of a personalized prevention plan that includes a screening schedule for appropriate preventive services. These visits are primarily for preventive planning and risk assessment, rather than hands-on physical examinations or diagnostic tests for specific ailments.

Financial Considerations and Frequency

Both the “Welcome to Medicare” Preventive Visit and the Annual Wellness Visit are generally covered at 100% by Medicare Part B. Beneficiaries typically pay nothing in terms of copayments, coinsurance, or deductibles for these specific preventive services. Full coverage applies when the service is performed by a healthcare provider who accepts Medicare assignment.

The “Welcome to Medicare” visit is a singular benefit, available only once during the first 12 months of a beneficiary’s Medicare Part B enrollment. For the Annual Wellness Visit, beneficiaries are eligible to receive this service once every 12 months, not strictly once per calendar year. This allows for consistent monitoring and updating of an individual’s personalized prevention plan.

While the wellness visits themselves are fully covered, additional services provided during the same appointment may incur out-of-pocket costs. If a healthcare provider performs diagnostic tests, treats a new or existing health problem, or conducts elements of a traditional physical exam for a specific concern, these services are distinct from the preventive visit. Such additional services may be subject to the standard Medicare Part B deductible, which is $257 in 2025, and the 20% coinsurance after the deductible has been met. Beneficiaries should confirm with their doctor’s office what services will be billed to avoid unexpected expenses.