Does Medicare Cover Annual Physicals?

Medicare Part B covers an annual wellness visit and a one-time Welcome to Medicare visit. Medicare Part B does not cover the more comprehensive exam many people may think of as a full physical exam.

Medicare Advantage (Medicare Part C) also cover an annual wellness visit. Some Medicare Advantage plans may also offer more comprehensive physical and wellness care benefits that Original Medicare (Part A and Part B) doesn’t cover.

A doctor smiles and talks with his patient during a physical exam

What is included in the Welcome to Medicare visit?

Your Welcome to Medicare preventive visit is a one-time visit that is covered by Medicare Part B within first 12 months that you are enrolled in Medicare Part B.

During your Welcome to Medicare visit, you and your doctor will review your medical history, which may include:

  • Height, weight and blood pressure measurements
  • A simple vision test
  • Certain screenings
  • Flu and pneumococcal shots

If you doctor accepts Medicare assignment, you typically pay nothing for your Welcome to Medicare visit.

If your doctor performs additional services or tests during your Welcome to Medicare visit that aren’t covered under the preventive benefits of Medicare Part B, you may have to pay a 20 percent Part B coinsurance (after you meet the Part B deductible, which is $185 per year in 2019).

If you enrolled in a Medicare Advantage plan when you were first eligible for Medicare Part B, your Medicare Advantage plan will cover your Welcome to Medicare visit within the first 12 months that you have the plan.

You must visit a doctor who is in your plan’s provider network.

If you have a Medicare Advantage plan, your coinsurance and deductible costs may vary. If a service is fully covered by Medicare Part B, it will be fully covered by your Medicare Advantage plan.

What is the Medicare Annual Wellness visit?

Once you’ve been enrolled in Medicare Part B for 12 months, you are eligible for an annual wellness visit each year.

During your Medicare annual wellness visit, you and your doctor can develop and update your personalized prevention plan to help prevent disease and disability based on your risk factors.

As part of this visit, your doctor will ask you to fill out a questionnaire known as a “Health Risk Assessment.”

Typically, your Health Risk Assessment will include:

  • A review of your medical and family history
  • Height, weight, blood pressure and other routine measurements
  • A list of risk factors and treatment options for you
  • A screening schedule for appropriate preventive services
  • A list of current health care providers and prescriptions

If your doctor accepts Medicare assignment, you typically pay nothing for your Medicare annual wellness visit.

You may have to pay Part B coinsurance, and the Part B deductible may apply if your doctor performs additional services or tests during your Welcome to Medicare visit that aren’t covered under the preventive benefits of Medicare Part B.

If you have a Medicare Advantage plan, your plan will cover your Annual Wellness Visit, as long as you visit a health care provider who is in your plan network.

Coinsurance and deductible costs can vary based on your plan.

Many Medicare Advantage plans offer additional wellness benefits

Medicare Advantage plans are sold by private insurers as an alternative to your Original Medicare benefits.

Every Medicare Advantage plan must provide at least the same benefits as Original Medicare. Many Medicare Advantage plans also offer benefits designed to help you live a healthy and active life.

Some of these benefits may include membership to fitness and wellness programs like SilverSneakers and services such as healthy home meal delivery.

Most Medicare Advantage plans also offer benefits and services that may include:

Plan benefits and availability can vary based on where you live.

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MedicareAdvantage.com is a website owned and operated by TZ Insurance Solutions LLC. TZ Insurance Solutions LLC and TruBridge, Inc. represent Medicare Advantage Organizations and Prescription Drug Plans having Medicare contracts; enrollment in any plan depends upon contract renewal.

Plan availability varies by region and state. For a complete list of available plans, please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.

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