Part of staying healthy is paying a regular visit to your doctor for an annual physical. These exams typically involve a consultation and physical medical exam from the doctor as well as lab tests. These exams play a key role in preventative health in older adults especially.
So a common question many people have is, “Does Medicare cover Annual Physicals?” In this article, we answer that question in clear, plain English.
Does Medicare Cover Annual Physicals?
The short answer is not really. In most cases, Medicare will not cover the cost of most annual physical exams. That said, this can be confusing because there are annual visits that Medicare will cover. Below we help you make sense of it all.
Original Medicare (Medicare Part A and Part B) does not provide coverage for many annual physical exams. So that means you will have to pay 100 percent for your annual physical exams.
However, there are annual doctor visits that Original Medicare does cover. It all gets confusing because they’re not technically physicals, however their names make them sound like they could be. So read on as we take a closer look at all this and help you understand exactly what Medicare covers.
Initial Preventative Physical Examination
Medicare provides coverage for an Initial Preventive Physical Examination. It is also known by many as the “Welcome to Medicare” physical.
That said, this is NOT a physical exam. It is a consultation where you and the doctor will talk about promoting health behaviors as well as preventing and detecting disease.
Coverage for Initial Preventive Physical Examination falls under Medicare Part B. This exam is a one-time visit that you can take advantage of within 12 months of enrolling in Medicare. Some of the key things a doctor does during the Initial Preventive Physical Examination include:
- medical history reviews
- preventive services education
- social health history reviews
If your healthcare provider accepts the assignment, this exam is free.
Annual Wellness Visits
Another program that Medicare covers are the Annual Wellness Visits. Again, this is not a full physical exam and is more of a consultation. It’s a chance for your doctor to stay up to date on your health and share advice on how to stay healthy.
Coverage for Annual Wellness Visits also falls under Medicare Part B. If your healthcare provider accepts the assignment, the Yearly Wellness Visit is free.
However, if your healthcare provider includes additional services in the bill, you may pay some copayment or deductible. Here are the following medical professionals that can provide this service:
- Nurse practitioner
- Certified clinical nurse specialist
- Physician assistant
- Health educator
- Registered dietician
Medicare Part B covers Annual Wellness Visits every 12 months. Some of the services included in an Annual Wellness Visit may consist of:
- Developing a personal prevention plan
- Completing a health risk assessment
- Updating your protection plan
Routine Physical Exams / Annual Physical
As for the “traditional” annual physicals many of us are familiar with, Original Medicare will not cover those. In fact, one of the laws that Medicare falls under, the Social Security Act, specifically says that routine physical exams are not covered by Medicare.
Medicare Advantage plans (Medicare Part C) also provide coverage for Initial Preventive Physical Examination and Annual Wellness Visits. They cover everything Original Medicare covers as well as some additional benefits. Out-of-pocket costs will vary depending on the specifics of your plan.
Original Medicare does not have to provide coverage for a routine physical examination. However, some Medicare Advantage plans (Medicare Part C) do cover them. So check with your plan provider to see if annual physicals are covered.
Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.
Additional Info on Medicare Coverage
This article is part of our series on “What does Medicare cover?”
Also, you can check out other articles in this series including: Does Medicare cover Xolair injections?