Does Medicare Pay for an Annual Physical?
Does Medicare pay for an annual physical? Learn what preventative care Medicare covers, including wellness visits, screenings, and cost details.
Medicare does not cover a traditional, comprehensive annual physical that typically includes a full hands-on examination and laboratory tests. Instead, Medicare focuses on preventative care through specific visits and screenings designed to assess health risks and promote wellness. This approach helps in early detection and management of potential health issues.
Medicare’s Preventative Care Visits
Medicare Part B offers two primary preventative visits that serve as alternatives to a traditional physical exam, aiming to keep beneficiaries healthy. The first is the one-time “Welcome to Medicare” Preventative Visit, also known as the Initial Preventive Physical Examination (IPPE). This visit is available during the first 12 months an individual has Medicare Part B. During this visit, a healthcare provider reviews medical and social history, measures height, weight, blood pressure, body mass index, and conducts a simple vision test. It also includes a depression risk and safety assessment, a personalized prevention plan, and a checklist of recommended screenings and shots.
Following the “Welcome to Medicare” visit, beneficiaries become eligible for an Annual Wellness Visit (AWV) once every 12 months. This yearly appointment is not a physical exam and typically does not include laboratory tests or hands-on physical assessments. The AWV involves updating a Health Risk Assessment, reviewing medical and family history, and developing or updating a personalized prevention plan based on current health and risk factors. Providers may also review current prescriptions, assess cognitive function, and discuss a screening schedule for appropriate preventative services. Both the “Welcome to Medicare” visit and the Annual Wellness Visit are generally covered at 100% by Medicare Part B, meaning no deductible or coinsurance applies, provided the healthcare provider accepts assignment.
Additional Preventative Screenings
Beyond the structured wellness visits, Medicare Part B covers a range of additional preventative screenings designed to detect health problems early. These screenings are separate from the Annual Wellness Visit and have their own specific coverage criteria and frequency limits. Medicare covers various cancer screenings, including screening mammograms for breast cancer (annually for women aged 40 and older), colorectal cancer screenings (e.g., colonoscopies, frequency varies), and prostate cancer screenings (annually for men aged 50 and older).
Cardiovascular disease screenings are covered to detect conditions early, and diabetes screenings are available if an individual has certain risk factors. Bone mass measurements are covered every two years for individuals at risk for osteoporosis. Medicare also covers various immunizations, such as annual flu shots, pneumonia shots, and Hepatitis B shots, with no out-of-pocket cost if the provider accepts assignment. Other covered screenings include glaucoma tests, depression screenings, and HIV screenings for those at increased risk.
Understanding Costs and Coverage
While the “Welcome to Medicare” visit and Annual Wellness Visits are covered at no cost, costs for other preventative services and potential additional charges vary. For many preventative screenings covered by Medicare Part B, such as certain cancer screenings and immunizations, there is no deductible or coinsurance if the provider accepts assignment. However, some screenings may require the Part B deductible to be met, and a 20% coinsurance may apply to the Medicare-approved amount.
A key distinction arises when diagnostic or treatment services are provided during a preventative visit. If a healthcare provider addresses a new or existing health problem, performs a comprehensive physical exam, or orders lab tests due to symptoms during a preventative visit, that portion of the visit may be billed as a separate office visit. These diagnostic or treatment services are subject to the Medicare Part B deductible and coinsurance. It is advisable to confirm coverage and potential costs with the doctor’s office or Medicare directly to avoid unexpected expenses.