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Medicare Wellness Visits vs. Physical Exams

(This article was originally published January 2018.)
February 2020

What’s Covered and What’s Not

Physical exams: You know you're supposed to get one every year. But did you know that Medicare doesn’t cover what you might think of as a traditional physical exam? However, Medicare does cover other types of preventive care to help you stay healthy and prevent illness.

Here’s a breakdown of the types of visits and services Medicare covers and does not cover. Before you make your next appointment, make sure you know what you’re getting—and what you’ll pay.

If You’re New to Medicare (Part B) If You’ve Been a Medicare Member 12 Months or Longer Ongoing Preventive Care

If You’re New to Medicare (Part B)

“Welcome to Medicare” Preventive Visit

(Also known as the Initial Preventive Physical Exam)

What's included in this visit?

Although this is often referred to as a physical exam, the purpose is actually to create a personalized plan and checklist for you. It may not include some of the services you received before you enrolled in Medicare, but it does include:

  • A review of your medical history and your health-related social history
  • Counseling about and recommendations for preventive services, screenings and immunizations
  • Height, weight and blood pressure measurements
  • A calculation of your body mass index (BMI)
  • A simple vision test
  • A review of your potential risk for depression and your level of safety
  • Referrals for other care, if needed

Does Medicare cover it?

Yes. However, if your doctor recommends other screenings or tests, such as an EKG, you may have out-of-pocket costs, such as coinsurance (what you pay for covered health care services after Medicare and/or insurance pays its share).

How often can I receive this service?

Once, within your first 12 months of enrollment in Medicare Part B.

 

If You’ve Been a Medicare Member 12 Months or Longer

Stethoscope
Yearly “Wellness” Visit

What's included in this visit?

During your visit*, your provider will:

  • Develop or update your personalized prevention plan/checklist
  • Conduct a health risk assessment
  • Create/update a list of your current health care providers and medications
  • Take height, weight, blood pressure and other routine measurements
  • Discuss your screening schedule (checklist) for appropriate preventive services

Does Medicare cover it?

Yes. However, if your doctor recommends other screenings or tests, such as an EKG, you may have out-of-pocket costs, such as coinsurance (what you pay for covered health care services after Medicare and/or insurance pays its share).

How often can I receive this service?

Yearly, after you’ve been enrolled in Medicare Part B for longer than 12 months.

What else should I know?

You must be enrolled in Medicare Part B. You don’t need to have participated in the “Welcome to Medicare” visit to receive your yearly “Wellness” visit.

*You may not receive some of the services you received during annual physical exams before you enrolled in Medicare.

 

Ongoing Preventive Care

Preventive & Screening Services Physical Exam


Preventive & Screening Services

What's included in this visit?

Services that help you stay healthy by preventing certain illnesses and health conditions, including:

  • Screenings for diabetes, cardiovascular disease, depression, colorectal and lung cancer
  • Mammograms
  • Healthy weight counseling

Does Medicare cover it?

Yes. Medicare generally covers 100% of recommended preventive services. Check the Medicare.gov website for coverage information about specific preventive services.

How often can I receive this service?

Depends on the service. Check Medicare.gov for details.

What else should I know?

For a preventive service to be covered by Medicare, you must meet age, gender and sometimes other Medicare requirements. Check Medicare.gov for more information.

 


Physical Exam

What's included in this visit?

A physical exam and/or tests that do not directly treat an illness.

A test or screening your doctor performs during a physical exam might not be covered by Medicare as a preventive service. Before getting any recommended tests or screenings, check the Medicare.gov website for details about coverage information.

Does Medicare cover it?

No. Medicare does not cover what is traditionally known as a “physical exam.” But you can still get one and pay the full cost for the visit.

How often can I receive this service?

As often as you want. However, Medicare will likely not cover the visit.

What else should I know?

Services not covered by Medicare aren’t covered by UC either, meaning you’ll pay out of pocket for this visit. Be sure this is the visit you want before scheduling your appointment.

 

Register at MyMedicare.gov to get direct access to your preventive health information—24 hours a day, every day. You can track your preventive services, get a 2-year calendar of the Medicare-covered tests and screenings you’re eligible for, and print a personalized “on-the-go” report to take to your next doctor’s appointment.