Does Medicare Require a Yearly Physical?
Clarify Medicare's coverage for preventative health. Discover which visits are covered annually, how they differ from a physical, and how costs work.
Medicare does not cover a traditional annual physical exam. Instead, Medicare Part B focuses on specific preventative care services designed to assess health risks and create personalized plans. Understanding these covered visits helps individuals manage their health.
Medicare’s Preventative Health Services
Medicare Part B provides coverage for two primary preventative visits that are often confused with a yearly physical. The first is the “Welcome to Medicare” preventative visit, a one-time service available within the first 12 months of enrolling in Medicare Part B. This visit establishes an initial health baseline, including a health risk assessment, review of medical and social history, routine measurements (blood pressure, vision, BMI), and counseling on preventative services and screenings.
Following the “Welcome to Medicare” visit, or after 12 months of Part B enrollment if the initial visit was not utilized, individuals become eligible for the Annual Wellness Visit (AWV). This yearly visit is a planning and counseling session. During an AWV, the provider updates the health risk assessment, reviews medical and family history, lists current providers and medications, conducts a cognitive assessment, and develops or updates a personalized prevention plan.
Accessing Your Preventative Visits
To utilize Medicare’s preventative visits, scheduling an appointment with your primary care provider is the initial step. Confirm the provider accepts Medicare assignment. When scheduling, inform the office staff that you are requesting your “Welcome to Medicare” preventative visit or your Annual Wellness Visit to ensure proper billing and service allocation.
Preparing for these visits helps maximize their effectiveness. Patients should gather relevant medical records, including immunization history, and list all current medications and supplements. Bring family health history to help identify potential risks. Prepare a list of health questions or concerns for discussion.
During the visit, individuals actively participate in the discussion with their healthcare provider. This collaborative approach allows for a thorough review of health status and the joint development of a personalized prevention plan. The focus remains on proactive health management and identifying appropriate screenings or services for the upcoming year.
Costs and Coverage for Preventative Care
The “Welcome to Medicare” preventative visit and the Annual Wellness Visit are generally covered at 100% by Medicare Part B. This means that individuals typically do not owe a Part B deductible or coinsurance for these specific services, provided the healthcare provider accepts Medicare assignment. This full coverage encourages proactive health management and early detection of potential issues.
While the preventative visits themselves are covered without out-of-pocket costs, additional services performed during the same appointment may incur charges. If diagnostic tests, screenings, or treatments for new or existing conditions are conducted that are not part of the standard preventative service, then standard Medicare Part B deductibles and coinsurance may apply. For example, the 2025 Medicare Part B annual deductible is $257, and after meeting this, individuals typically pay 20% of the Medicare-approved amount for most services. It is advisable to discuss any potential additional costs with the doctor or their administrative staff beforehand to avoid unexpected bills.