Does Medicare Pay for an Annual Physical?
Unsure if Medicare pays for your annual physical? Learn about Medicare's covered preventive services and how they differ from a traditional exam.
Medicare’s Preventive Health Services
Many individuals wonder if Medicare covers a traditional annual physical. Original Medicare, specifically Part B (Medical Insurance), generally does not cover a routine head-to-toe annual physical examination. This comprehensive exam, often including extensive lab work and hands-on physical assessments, is not a covered benefit under Medicare Part B. Instead, Medicare’s coverage focuses on specific preventive services designed to help beneficiaries maintain their health and detect potential problems early.
Medicare’s approach to preventive care focuses on proactive health management. These services include the “Welcome to Medicare” preventive visit and the “Annual Wellness Visit,” which serve distinct purposes from a traditional physical. While a traditional physical aims to diagnose and treat existing medical conditions, Medicare’s preventive visits assess health risks, provide health education, and develop personalized prevention plans.
Your Welcome to Medicare Visit
The “Welcome to Medicare” preventive visit is a one-time benefit for new Medicare beneficiaries. This visit can be scheduled within the first 12 months of enrolling in Medicare Part B. It serves as an initial assessment, establishing a health baseline for future care. This visit is not a traditional physical exam, but an opportunity to discuss your health with your provider.
During this visit, your healthcare provider will review your medical and social history, including family health history, and assess your potential for depression and other mental health conditions. They will also take routine measurements such as height, weight, blood pressure, and vision, and calculate your Body Mass Index (BMI). The goal is to identify potential health risks and provide education and counseling about appropriate preventive services and screenings you may need.
The provider will also discuss your ability to function safely in your home and community and may offer information on advance care planning. You will receive a personalized checklist or written plan outlining recommended screenings, shots, and other preventive actions. This visit is an important step in understanding your health status and planning for your future healthcare needs.
Your Annual Wellness Visit
Following your “Welcome to Medicare” visit, or after you have had Medicare Part B for more than 12 months, you become eligible for an Annual Wellness Visit (AWV) once every 12 months. This visit is distinct from a traditional physical exam and does not include a hands-on physical examination or extensive lab tests. Its focus is on health promotion and creating or updating a personalized prevention plan.
During your Annual Wellness Visit, your provider will ask you to complete a Health Risk Assessment questionnaire. This assessment helps identify potential health risks and allows your provider to develop a tailored prevention plan. The visit also includes routine measurements like height, weight, and blood pressure, and a review of your current medical and family history.
The Annual Wellness Visit also involves screening for cognitive impairment, such as memory loss or signs of dementia, and provides an opportunity to discuss advance care planning. Your provider will review your current medications and create a written screening schedule for appropriate preventive services. This visit ensures you receive recommended preventive care to maintain your health and well-being.
Costs Associated with Preventive Care
For beneficiaries with Original Medicare, the “Welcome to Medicare” preventive visit and the Annual Wellness Visit are covered at 100% of the Medicare-approved amount, meaning you pay no coinsurance or deductible if your doctor accepts Medicare assignment. This full coverage applies specifically to the preventive services included in these visits. However, additional services or tests performed during the same visit may incur separate costs.
If your healthcare provider identifies a new health problem or decides to investigate an existing one during the preventive visit, any diagnostic services, treatments, or additional tests not considered part of the preventive service may be subject to standard Medicare Part B deductibles and coinsurance. For instance, if blood work is ordered to diagnose a specific condition rather than as part of a general screening, you may be responsible for a portion of those costs. Clarify with your provider if any services will be billed separately.
Medicare Advantage Plans (Part C) are required to cover at least all the benefits that Original Medicare covers, including the “Welcome to Medicare” visit and the Annual Wellness Visit. While these plans must provide the same level of preventive care, they may have different cost-sharing structures, such as copayments or deductibles, for other services. Review your specific plan details.