Does Medicare Pay for Annual Physicals?
Understand Medicare's coverage for annual physicals and preventive visits. Learn what's covered, what isn't, and how different plans approach routine check-ups.
Many new Medicare beneficiaries ask about coverage for annual physical examinations. While private insurance often covers a comprehensive yearly physical, Medicare’s approach to preventive care differs. It focuses on specific visits designed to promote health and detect potential issues early.
Understanding Medicare’s Approach to Preventive Health
Original Medicare Part B does not cover a traditional, comprehensive physical examination. Instead, Medicare emphasizes preventive services through structured visits for health planning, risk assessment, and disease prevention. These services help beneficiaries stay healthy and identify potential health concerns early.
Medicare’s preventive visits focus on proactive health management. They involve reviewing health history, providing health education, and developing personalized prevention plans. The two primary types of covered preventive visits are the “Welcome to Medicare” preventive visit and the Annual Wellness Visit.
The “Welcome to Medicare” Preventive Visit
Medicare offers a one-time “Welcome to Medicare” preventive visit for new beneficiaries, available during the first 12 months of Medicare Part B enrollment. It serves as an initial health assessment to establish a baseline for future care.
During this visit, a healthcare provider reviews your medical and social history, including potential risk factors for depression. It also includes routine measurements such as height, weight, blood pressure, and basic vision screening. The visit helps create a plan for future screenings and preventive services, but it is not a comprehensive physical exam.
The Annual Wellness Visit
After the “Welcome to Medicare” visit, or 12 months into Medicare Part B enrollment, beneficiaries are eligible for an Annual Wellness Visit (AWV) once every 12 months. This visit focuses on developing or updating a personalized prevention plan based on current health and risk factors. The AWV includes a health risk assessment, a review of medical and family history, and an update of providers and medications.
During the AWV, routine measurements like height, weight, and blood pressure are taken. Providers also conduct a cognitive impairment assessment and offer personalized health advice. The Annual Wellness Visit does not include a physical exam, lab tests, or treatment for new or existing conditions.
Costs and Coverage for Additional Services
Both the “Welcome to Medicare” preventive visit and the Annual Wellness Visit are covered at 100% by Original Medicare Part B. Beneficiaries typically pay no Part B deductible or coinsurance when the healthcare provider accepts Medicare assignment.
However, if additional services are provided during these visits, such as blood tests or treatment for a new condition, standard Medicare Part B deductibles and coinsurance apply. Beneficiaries should clarify with their provider if any services beyond the preventive visit components will incur additional charges.
Medicare Advantage Plans and Physicals
Medicare Advantage (Part C) plans must cover all Original Medicare benefits, including the “Welcome to Medicare” and Annual Wellness Visits. These plans typically cover these visits without applying deductibles, copayments, or coinsurance when using in-network providers.
Many Medicare Advantage plans offer additional benefits not covered by Original Medicare, such as a traditional annual physical exam. The scope of these additional benefits varies by plan. Beneficiaries should review their plan documents or contact their provider to understand covered preventive services and associated costs.