Does Medicare Cover Yearly Physical Exams?

Regular physical exams are important to make sure that you are healthy and to identify if you have any illnesses or diseases. That is why yearly physical exams are highly recommended for everyone – no matter what your age.

But, if you don’t have insurance, these exams are not free. This leads many to ask the question, “Does Medicare cover yearly physical exams?”

In this article, we answer this question in clear, plain English. You will also find the average costs of annual physical exams if you do not have insurance coverage.

Does Medicare Cover Yearly Physical Exams?

The short answer is no. In most cases, Medicare will not cover the cost of most yearly physical exams. That being said, there may be some situations where you can get these costs covered.

Below we’ll take a closer look at this to see when you might be able to get Medicare to pay for your annual physical exams.

Original Medicare Coverage of Yearly Physical Exams

First, Original Medicare (Medicare Part A and Part B) does not cover many routine physical exams. This means you will have to pay 100 percent of your annual physical exams.

However, Original Medicare provides coverage for similar exams such as Initial Preventive Physical Examination and Annual Wellness Visits.

Medical Coverage of Other Physicals

Original Medicare provides coverage for Initial Preventive Physical Examination. Many also know it as the “Welcome to Medicare” physical.

Medicare Part B Coverage

Part B of Original Medicare covers the Initial Preventive Physical Examination. This physical exam is a one-time test that a beneficiary must complete within 12 months of enrolling in Medicare Part B.

Some of the tests that the Initial Preventive Physical Examination includes consist of the following:

Medical history reviews
Preventive services education
Social health history reviews

If your healthcare provider accepts the assignment, this type of physical exam is free.

Another program that includes a physical exam that Original Medicare covers is Annual Wellness Visits. Medicare Part B provides coverage for Annual Wellness Visits.

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:

Doctor
Nurse practitioner
Certified clinical nurse specialist
Physician assistant
Health educator
Registered dietician

Medicare Part B provides coverage for 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

However, this visit typically does NOT include any physical exam.

Medicare Advantage Coverage of Yearly Physical Exams

On the other hand, Medicare Advantage plans (Medicare Part C) typically provide coverage for routine physical exams. Medicare Advantage plans cover everything Original Medicare covers but will also offer additional benefits Original Medicare does not. In many cases, this includes a yearly physical exam.

However, exactly what a plan covers and how much the out-of-pocket costs will be varies depending on the specifics of your plan.

Medicare Advantage plans (Medicare Part C) also provide coverage for Initial Preventive Physical Examination and Annual Wellness Visits.

How Much Does Annual Physical Tests Cost?

Annual physical tests usually cost from $50 to $200 if you do not have insurance coverage. However, depending on the exams and tests performed, the costs may end up being higher than that.

Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage. 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.