Medicare does not cover the cost of the comprehensive annual medical exam, commonly referred to as a physical. However, it does cover a one-time checkup and a yearly wellness appointment.
While Original Medicare (parts A and B) does not cover a yearly physical, it covers some preventive services to help keep you in good health. This includes:
- A “Welcome to Medicare” one-time checkup in the first year following your enrollment date in Medicare Part B (medical insurance).
- A wellness visit every year to develop and update a personal prevention plan.
It also covers doctor’s office visits when they’re intended to diagnose or treat a medical complaint.
If you have a Medicare Advantage (Part C) plan, these plans must cover at least as much as Original Medicare does. But, some Advantage plans provide additional benefits, so it’s best to check with your plan provider for more details.
Learn what the Welcome to Medicare appointment and your annual wellness appointment involve.
Your Welcome to Medicare checkup is considered a preventive visit. But it is less detailed than an annual physical.
The welcome exam includes a review of your medical history and, as it relates to your health, your social history. It also provides education and counseling about preventive services.
In contrast, a physical exam may involve checking you for specific diseases and administering vaccinations.
What to expect
As part of your welcome to Medicare checkup, you should expect the following:
- routine measurements, such as weight, height, and blood pressure
- BMI (body mass index) calculation
- certain screenings
- personalized health advice
- a simple vision test
- review of risk potential for depression
- option to talk about advance directives, or voluntary advance care planning
- referrals to other healthcare professionals, if needed
- a written schedule of preventive services, such as vaccines (including a yearly flu shot, pneumococcal shots, and recommended COVID vaccines) and screenings (such as for diabetes, colon cancer, and prostate cancer)
How much does the welcome visit cost?
With Original Medicare (parts A and B), you should not have to pay for this visit if your doctor accepts Medicare.
If a doctor performs additional tests or services during your welcome visit that are not covered under Medicare’s preventive benefits, you may have to pay coinsurance of 20% of the cost of the services, and your Part B deductible may apply. This can include if you have symptoms of a health condition or if a doctor suspects you may have one, as the services would no longer be considered preventive but diagnostic.
If your doctor does not accept Medicare or the Medicare-approved cost for a service, you may have to pay additional fees out of pocket.
Annual wellness visits assess your current health and risk factors and develop a prevention plan to help prevent disease and disability. But, they are not comprehensive physical exams. A physical exam typically includes comprehensive exams that a doctor performs regardless of any specific complaints, health concerns, injuries, or illnesses you have.
What to expect
Annual wellness visits usually include an assessment to monitor you for symptoms of cognitive impairment and memory loss. You typically also fill out a health risk assessment questionnaire to help develop a personalized wellness plan. The questionnaire may include:
- routine measurements, such as weight, height, and blood pressure
- review of your medical history and your family’s medical history
- an update on current health, such as health concerns, providers, and current prescriptions
At the end of your wellness visit, a healthcare professional typically provides:
- personalized health advice, such as a list of risk factors and treatment options
- advance care planning, such as a screening schedule of preventive services
- indication of any cognitive impairment
How much does an annual wellness visit cost with Medicare?
Original Medicare typically covers the cost of this visit as long as the healthcare professional and the facility accept Medicare and the Medicare-approved cost of the service.
Your Part B deductible may apply, and you may have to pay coinsurance if a healthcare professional performs additional tests or services during your wellness visit that are not covered under the preventive benefits.
Although Medicare does not cover what we tend to call an annual physical, Original Medicare does cover the following:
A Welcome to Medicare visit that covers routine measurements, certain screenings and shots, and other preventive actions.
Annual wellness visits to help in the development of a personalized wellness plan.
With Original Medicare, these visits are covered unless your doctor performs additional tests or services not covered in this exam. You may have to pay the coinsurance cost if they perform additional services.